Showing posts with label governor. Show all posts
Showing posts with label governor. Show all posts

Sunday, 29 May 2016

Princess Health and  State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

The state's revised Medicaid program won't require any beneficiaries to pay premiums, but it may offer fewer benefits, Medicaid Commissioner Stephen Miller told Adam Beam of The Associated Press.

But Gov. Matt Bevin's office told Beam that Miller's comments were preliminary: "Everything is on the table and no decisions have been finalized," spokeswoman Jessica Ditto told him.

Bevin has said Medicaid recipients should have some "skin in the game" and has pointed to Indiana, which received a federal waiver allowing it to charge premiums based on income levels to people who want benefits beyond the basic Medicaid program.

The idea drew strong opposition from health-care providers, consumer advocates, public-health professionals and representatives of higher education in a May 12 meeting, according to the Foundation for a Healthy Kentucky, which convened the gathering.

"Miller said negotiations with officials at the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, indicate they will not approve a plan that requires Kentucky's expanded Medicaid population to pay for a portion of their health insurance," Beam reports.

Miller told him, "That, today, is not part of the plan. That is something that's going to be a tough sell."

Bevin is seeking changes that will save the state money. Starting Jan. 1, it will have to pay 5 percent of the costs of those who have joined Medicaid under the expanded eligibility created by the federal health-reform law. Its share will rise in annual steps to the law's limit of 10 percent in 2020. The state's expected bill for 2017 and the first half of 2018 is $257 million.

Now it seems that savings are likely to come by cutting benefits. "Miller said some Medicaid recipients could see fewer benefits under the new plan," Beam reports. "He said the health insurance plan for the state's Medicaid recipients is better than the basic plan offered to state employees. He said the new plan will likely bring the Medicaid plan more in line with the health plan offered to state workers." Miller said, "That would be a reduction in some benefit levels, such as in vision, dental."

Also, Miller said the program could encourage healthier behaviors by funding health savings accounts if they did such things as participating in smoking-cessation and weight-loss programs. "It may sound like we are rewarding them for that, but the long-term effect is it makes their health care coverage less expensive,"  Miller told Beam.

He said the state hopes to submit its waiver application in September. HHS spokesman Ben Wakana, told Beam that any changes "should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security." Before the expansion; 20 percent of Kentuckians had no health coverage; now the figure is 7.5 percent.

Sunday, 1 May 2016

Princess Health and State and national smoke-free leaders tell Ky. advocates to focus on local smoking bans because of political climate in Frankfort. Princessiccia

By Melissa Patrick
Kentucky Health News

More Kentucky localities are likely to see efforts for smoking bans, as a statewide ban appears less likely and leading advocates are saying to go local.

Stanton Glantz
photo: ucsf.edu
Stanton Glantz, one of the nation's leading advocates of smoke-free policies, said at the Kentucky Center for Smoke-Free Policy's spring conference April 28 that California initially had trouble passing a statewide indoor smoke-free law, which forced advocates to move their efforts to the local level. By the time the statewide law passed, 85 percent of the state was covered by local ordinances.

"I'm glad it worked out that way, because we are really talking about values and social norms and community norms and you just can't impose that from the outside," Glantz said during his keynote address. "And so all of these fights that you are having in all of these towns. ... In the end, when you win, you've won. And the fight itself is an important part of making these laws work."

Ellen Hahn, a University of Kentucky nursing professor and director of the smoke-free policy center, also encouraged her colleagues to shift their efforts to localities, saying the political situation doesn't support a statewide law. New Republican Gov. Matt Bevin doesn't support a statewide ban on smoking on workplaces, saying the issue should be decided locally.

"We are in a very difficult political climate in Frankfort," Hahn said in her opening remarks."We all know it. We all recognize it. And while we would all like to see Frankfort do the right thing � and it will someday, I promise � it is not the time to let somebody else do it. It is the time to go to your local elected officials and say we want this."

Advocates made some headway last year when a smoking-ban bill passed the House, but it was placed in an unfavorable Senate committee and never brought up for discussion. This year's House version of the bill, in an election year with Bevin in the governor's office, was dead on arrival.

Glantz, a University of California-San Francisco professor and tobacco-control researcher, looked at the bright side: "You're in a tough political environment, but you are really doing pretty well." He reminded the advocates that one-third of the state is covered by indoor smoke-free ordinances, with 25 of them comprehensive and 12 of them including electronic cigarettes. He also commended the Kentucky Chamber of Commerce for supporting statewide and local bans.

What's next

Glantz urged the advocates to "empower and mobilize" the 73 percent of Kentuckians who don't smoke and get them to help change the social norms. Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to latest Kentucky Health Issues Poll, and have since 2013.

�The whole battle is a battle about social norms and social acceptability, and once you win these fights, and you have a law that�s sticking � which takes a while � you don�t go back,' he said. "And the tobacco companies understand that, and that is why they are fighting us so hard.�

Glantz armed the smoke-free warriors with research data to support smoke-free laws, including: they decrease the number of ambulance calls; hospital admissions for heart attacks, stroke, asthma and chronic obstructive pulmonary disease; and the number of low-birth-weight babies and complications during pregnancy.

"In Kentucky communities with comprehensive smoke-free laws, there was 22 percent fewer hospitalizations for people with COPD," Glantz said, citing one of Hahn's studies. "That is a gigantic effect, absolutely gigantic, at almost no cost and it happened right away."

He noted that politicians are usually most interested in this short-term data, but he also cited long-term statistics about how smoke-free policies in California have decreased heart disease deaths by 9 percent "in just a few years," and lung cancer by 14 percent in about 10 years. Kentucky leads the nation in both of these conditions.

"I would argue that the economic argument is actually on our side," Glantz said, noting that economic benefits of smoke-free laws are almost immediate, especially because "every business, every citizen and every unit of government" is worried about health care costs. He also cited research that found "as you pass stronger laws, you get bigger effects.'

Saturday, 16 April 2016

Princess Health and Governor kills bill that would have encouraged donation of organs and bone marrow; sponsor's primary foe is son of Bevin appointee. Princessiccia

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has vetoed a bill that would have allowed Kentuckians to take time off of work to be "living donors" or donate bone marrow without risk of losing jobs or income. The bill would have required paid leave of absence for such reasons, and offset the cost to the employer with tax credits.

Rep. Ron Crimm
"I was deeply disappointed," Republican Rep. Ron Crimm, sponsor of the bill, said in a telephone interview. "I thought it was a very good bill."

Crimm, from Louisville, said the Republican governor called him and told him it was a good bill, but that he wasn't accepting anything that would generate a cost to the state.

Bevin said in his veto message, "House Bill 19 is a noble and well-intentioned piece of legislation designed to encourage the generosity of time and financial resources by both individuals and employers. However, the financial costs and administrative burden on the Department of Revenue to implement House Bill 19 far outweigh the limited benefit this legislation can provide."

The Legislative Research Commission's fiscal note on HB 19 says it would cost about $100,000 to set up the system, but future cost would be "minimal." Crimm said he didn't think it would cost that much to set it up and that he told the governor so.

HB19 is modeled after a similar program in Pennsylvania, which allowed LRC staff to look at the fiscal impact of its tax credit as a point of comparison. They found that in a four-year period, Pennsylvania had only three taxpayers claiming a donor credit for a total of $3,505.

"Therefore,staff estimates that the revenue impact of the credit permitted by HB 19 would also be minimal," says the fiscal note. Crimm said, "It's nothing."

Tom Loftus of The Courier-Journal noted that Crimm faces a "stiff primary election" May 17 against Jason Nemes and that Nemes' father, Mike Nemes, a former state representative, is Bevin's deputy labor secretary.

Asked if he thought this might have influenced the governor's veto, Crimm laughed and said, "If that is true, then I'm very, very disappointed that I supported him." Then he said, "I don't think the governor would have done that." But then he said, using what he said is an old "Pennsylvania Dutch" expression, "It wonders me. ... Everybody, one-hundred-percent of the people in the House and the Senate, voted yea on the bill." The legislation passed 95-0 in the 100-member House and 37-0 in the 38-member Senate.

Friday, 25 March 2016

Princess Health and  Ky. Republicans like Indiana Medicaid plan, but head of Medicaid directors' group says Ind. isn't far enough along to be a model. Princessiccia

Princess Health and Ky. Republicans like Indiana Medicaid plan, but head of Medicaid directors' group says Ind. isn't far enough along to be a model. Princessiccia

Gov. Matt Bevin and other Republicans have said they want to make Kentucky's version of Medicaid look like Indiana's, but a leading Medicaid official says that Indiana's program hasn't proven itself to save money or improve health, so it's unlikely other states will be allowed to use it as a model, Phil Galewitz reports for Kaiser Health News and The Washington Post.

Matt Salo, executive director of the National Association of Medicaid Directors, told Galewitz, �Other states have looked at it, but the Obama administration has made it pretty clear that Indiana is going to be a test case and much evaluation will need to be done before they approve any more like it.�

Now Bevin's office says it is looking at other states, too, as it negotiates with the U.S. Department of Health and Human Services, trying to come up with a revised program to save money, perhaps by August.

"The Indiana model is just one of many models that we are looking at for influence in crafting a plan that is specifically tailored for the needs of Kentucky," Bevin spokeswoman Jessica Ditto said in an e-mail. "We are working closely, and in good faith, with HHS as this process moves forward and have confidence that what we offer for their consideration will be a thoughtful, deliberate and unique plan that will improve health outcomes in a sustainable manner."

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

Bevin has said that Kentucky's revised program should require its members to have "skin in the game," and that the state cannot continue to pay for the health insurance of "able-bodied adults."

Healthy Indiana Plan

That sounds like Indiana, which has monthly fees and co-payments and refers its participants to a work program.

Even if it is just a dollar, everyone on Medicaid in Indiana pays something, whether it's through a monthly fee or through co-payments.

The Healthy Indiana Plan has two levels, HIP Plus and HIP Basic. Both plans offer incentives for using preventive services, but HIP Plus, which requires a monthly fee, also includes dental and vision services.

Those fees go into an account that is like a health savings account and is used for the first $2,500 of medical expenses each year. The state of Indiana pays the bulk of the $2,500 and if the participant's health-care expenses exceed this amount, the state will pay for the additional care at no cost to the individual.

HIP Plus is considered the best value and is available to everyone in the state with income below 138 percent of the federal poverty level. The consequences for not paying the required monthly fee vary by income level.

Those in HIP plus who make at or below the poverty level and fail to pay the fee are moved down to HIP Basic plan, which requires co-payments of up to $8 per service and $75 for each inpatient hospital stay. Both plans have a co-payment for using the emergency room for non-emergency reasons, $8 the first time and then $25 per visit thereafter.

HIP Basic members who make more than the poverty level are locked out of coverage for six months if they fail to make their monthly payment.

"No other program has been allowed to require health spending accounts, much less threaten to yank coverage for a person not paying in," Galewitz writes, paraphrasing Salo.

HIP members who are unemployed or work less than 20 hours a week are referred to available employment, work search and job training programs to help them gain employment or find better employment. This is a free and voluntary program and does not affect the receipt of benefits.

All members of HIP Plus must pay something. About half of Indiana Medicaid members have annual incomes below $600; they must pay a $1 monthly premium.

The monthly fee adjusts with income and family size. For example, a single person who makes $16,242, the maximum for expanded Medicaid, pays $27.07 per month to get HIP Plus, or $324.85 per year. A family of two could make as much as $21,983 and would pay $36.64 or $439.68 per year; and a family of four could make $33,465 and would pay $55.78, or $669.36 per year. Information comes from the eligibility calculator on the Healthy Indiana Plan website.

Is Indiana's plan working?

Indiana health officials told Galewitz that 94 percent of those who have signed up for HIP Plus continue to pay their fees.

Michelle Stoughton, senior director of government relations for Indianapolis-based Anthem Insurance Cos., called that a success. She said nearly 75 percent of Anthem's members on this HIP Plus have visited a dentist, and 65 percent sought vision care in the first three months of coverage. Anthem is one of three private insurers providing coverage under the Healthy Indiana Plan.

�What we heard for years .?.?. is that these people won�t pay and don�t have the ability to pay,� Stoughton told Galewitz. �But this has turned those arguments around and been able to show that people do want to be engaged.�

Indiana's hospitals and doctors support the Healthy Indiana Plan, mostly because the state increased their Medicaid rates, hospitals by an average of 20 percent and doctors' reimbursements by an average of 25 percent, Galewitz reports.

"As a result, Medicaid has gained more than 5,300 providers in the past year, and patients report few problems getting care," he writes. But he also noted that about 2,200 members have lost coverage since it began in May 2015 because they didn't pay their monthly fees.

Critics of Indiana's plan worry that the monthly payments and complicated structure will keep the poor from getting care. which goes against the core goal of Medicaid expansion, Galewitz writes. In addition, some conservative groups say the program may be more expensive than traditional Medicaid, because it provides dental and vision care and pays providers more. Others say that the red tape in the plan exceeds that of any state's Medicaid expansion.

The state had also hoped third parties would step up and help the poor pay for their monthly contributions, but this hasn't happened, Joan Alker, executive director of the Georgetown University Center for Children and Families, told Galewitz. She said, �It�s premature for Indiana to take a victory lap.�

Wednesday, 23 March 2016

Princess Health and  At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

By Melissa Patrick
Kentucky Health News

With a verve for Obamacare most had not publicly demonstrated, state House Democrats passed bills March 22 to preserve the Kynect health insurance exchange and the state's expansion of the federal-state Medicaid program.

The almost entirely party-line votes were a response to Republican Senate President Robert Stivers, who had challenged the House to act on the bills so the public will know where legislators stand on health reform.

The Senate is not expected to pass House Bills 5 and 6, but may use them as a device for debate of an issue on which Republicans seem to think they have had the upper hand. Democrats appear to think otherwise.

"This is a political issue, we all know that," House Speaker Greg Stumbo said. "The president of the Senate wanted to challenge us to talk about it, so I think we ought to talk about it because . . . Kynect is working."

(The debate begins four minutes into the following KET video. The continuation of the debate can be seen here.)

Kynect, where Kentuckians can sign up for Medicaid or buy federally subsidized health insurance, was established under executive order with federal grant money by then-Gov. Steve Beshear, a Democrat. It is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which health reform made unnecessary.

Gov. Matt Bevin and other Republicans say Kynect is not necessary because the federal exchange, used by most states, does the same thing. "We will still be providing Kentuckians with access to care," said Rep. Addia Wuchner, R-Florence. "It will be as easy as going to a different website."

Democrats say using the federal exchange will leave Kentuckians without enough of the assistance needed by people who are unfamiliar with health insurance. More than 400,000 Kentuckians have used Kynect to sign up for Medicaid and about 100,000 have used it to get health insurance, many with the help of Kynect-paid "Kynectors."

Rep. Darryl Owens, D-Louisville, the bills' sponsor, said many people in Kentucky don't have access to the Internet and that many who do are not "tech savvy." He said that a decrease in the number of helpers, who are available to meet clients after hours and at convenient locations, will create additional barriers to access for many Kentuckians.

Rep. Kelly Flood, D-Lexington, told the House about one of her constituents who learned in the middle of a family medical crisis that they had been dropped from Medicaid. Flood said the woman told her she could not "reach that wonderful Kynector who used to tell me what was going on."

The Kynector later told her that "she had been swamped with others like her who wanted to know what was happening to the stability of their health care that they had just secured," Flood said. "It is so much more complicated than just going to a new website. I am wanting us to understand the people whose lives are on the line."

The state, completing a plan put in place by the Beshear administration, recently shifted Medicaid users of Kynect to a new system called Benefind that handles most public-assistance programs.

Emily Beauregard, executive director for Kentucky Voices for Health, told Greg Stotelmyer of Public News Service that the wait times on Benefind are two hours and 6,000 to 7,000 calls are going unanswered each day. Advocates have said that the average wait time on Kynect is two minutes.

Cabinet for Health and Family Services spokesman Doug Hogan told Stotlemyre that there had been "difficulties" with the transition and the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

The House voted on the bills separately but the main debate touched on both Kynect and Beshear's expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. The federal government is paying for the expansion until next year, when states will begin paying 5 percent, rising to the law's limit of 10 percent in 2020.

Bevin and other Republicans say that is not sustainable, and he is negotiating with federal officials to change Medicaid to save money and add more personal responsibility, such as premiums, co-payments and deductibles.

Rep. Joni Jenkins, D-Louisville, chair of the House Budget Subcommittee on Human Services, said most Kentuckians who get insurance through Kynect and expanded Medicaid work in low-income jobs and without the program cannot afford insurance.

"With all of this great news -- more people covered, profitable hospitals, more jobs, better health care and wellness -- I believe the evidence is overwhelming that Kentucky must keep Kynect and expanded Medicaid," Jenkins said.

At times the debate was more about federal health reform in general than about the specifics of Kynect or Medicaid expansion.

Rep. Jim Gooch, a Providence insurance agent who recently became a Republican, said many Kentuckians have been helped by Obamacare, others have been hurt. He said many can't afford their co-payments and deductibles, and he said President Obama lied when he said people could keep their old health plans and doctors if they wanted after the reform law passed in 2010.

Another insurance agent, Rep. Jeff Greer, D-Brandenburg, argued the other side. He said the Patient Protection and Affordable Care Act had brought many people their first affordable health insurance, especially those with pre-existing conditions, and relieved many farmers of the need to to work another job to get insurance.

"What I see is that we have something that is working, and I'm in a field where I see it work and yet we want to dismantle it and go to something that we're not sure is gong to work or not, Greer said. "I just don't get it."

House Minority Leader Jeff Hoover, R-Jamestown, said using the federal exchange "will not cause a single policy to be canceled or a single person to lose coverage." He said 36 other states now use the federal exchange "seamlessly."

Hoover and other Republicans said the debate was overdue, referring to Beshear's executive actions that the legislature was unable to block.

The Kynect bill passed 52-46, followed by a 54-44 vote for the Medicaid expansion, with Republican Reps. Jim DuPlessis of Elizabethtown and Jim Stewart of Flat Lick joining the Democrats. Reps. Gerald Watkins, D-Paducah, and David Floyd, R-Bardstown, did not vote on either bill.

All House seats are on the November ballot. House Democratic Caucus Chair and state party Chair Sannie Overly was asked how a vote for Obamacare might affect the election. "I think that House Bill 5 and 6 are simply a message to others that we stand by our commitment to providing access to healthcare to all Kentuckians," she said. "We've seen that our constituents support making sure that their friends and neighbors and relatives have access to health care."

To the same question, Rep. Robert Benvenuti, R-Lexington, said, "I think the voters have already thoughtfully evaluated that and cast a strong vote for Gov. Bevin, so I do think it will come up again in these November elections."

Saturday, 19 March 2016

Princess Health and Republicans accuse Beshear of holding down failed co-op's premiums to make Obamacare look good; he denies the charge. Princessiccia

By Al Cross
Kentucky Health News

Did Kentucky's government-sponsored insurance company fail because then-Gov. Steve Beshear and federal officials kept its rates artificially low to make Beshear's embrace of federal health reform look better?

Sen. Ralph Alvarado
That's what Republican state Sen. Ralph Alvarado of Winchester, using documents provided by Gov. Matt Bevin's office, suggested or claimed March 14 in a Senate floor speech about the Kentucky Health Cooperative.

"It appears that rates for the co-op may have been purposely kept down for the sake of optics, to make the rollout of the ACA in Kentucky appear successful when it clearly was not," Alvarado said, citing "multiple meetings between the co-op, the governor's office and CMS," the federal Centers for Medicare and Medicaid Services, which oversees the state-based co-ops created under the reform law, in the fall of 2014.

"Somewhere along the way rates were kept down despite these actuarial recommendations," which said the money-losing cooperative should increase its rates 35 to 40 percent for the 2015 plan year, Alvarado said. The co-op's average increase, announced in late October 2014, was 15 percent. In November, CMS expanded the co-op's $47 million solvency loan to $125 million "to try to sustain this company," he said.

Beshear denied the charges through a spokeswoman, Hayley Prim. She said in an email, "Rates were set by the co-op, which was a privately run insurance plan. Like all other insurance plans, the rates must be certified by the Department of Insurance and actuarially sound. The state did not hold rates artificially lower to improve optics."

CMS officials encouraged co-ops "to price their plans low and grow as fast as they could," Adam Cancryn reported for SNL Financial in November 2015, in a long article that is widely regarded as the best written about the failure of the co-ops. Twelve of the 23 have closed or plan to.

The insurance co-op's offices are in eastern Jefferson County.
In December 2014, the Kentucky Health Cooperative reported a loss of $50 million, "with several hazardous financial conditions indicated," Alvarado said, but that year its chief executive officer, chief financial officer and member-services vice president got bonuses of $50,000, $40,000 and $40,000 on top of their salaries of $250,000, $179,000 and $131,000.

"This company had no money, was in deficit, and yet funds were being used clearly for bonuses," Alvarado said. Its CFO, Leonard Sherman, left the company in December 2014, according to a document filed by its liquidators.

Joe Smith of Frankfort, who was chair of the cooperative's now-dissolved board, said in an interview that the salaries and bonuses were "probably a little bit less" than typical in the insurance industry. He said bonuses were paid because the co-op enrolled many more customers than expected, but no bonuses were paid after the first year.

Smith blamed "the Republican Congress" for killing the co-op and those in many other states by limiting the "risk corridor" subsidies paid to insurance companies for covering sicker-than-average populations.

He acknowledged that the Obama administration largely abandoned the co-ops, making them "a sacrificial lamb," but he said they could not effectively compete with large insurance companies, mainly because the reform law prohibited them from advertising, as the big insurers wanted. The law created funding for the not-for-profit cooperatives as a way to provide competition with for-profit insurers and hold premiums down.

Janie Miller, who was Beshear's first health secretary, resigned as CEO of the Kentucky Health Cooperative in June 2015. That October, the co-op said it had largely eliminated its losses but would close because it was getting only a $9.7 million of a $77 million risk-corridor subsidy that it needed to stay afloat. It is now in liquidation, supervised by Franklin Circuit Court.

Alvarado said Miller and her successor, Glenn Jennings, refused to appear at a legislative budget subcommittee meeting in November. He said the Insurance Department "gave us very limited answers about what happened, [which] made me wonder if any wrongdoing was involved."

Alvarado said the legislature's Program Review and Investigations Committee should examine the co-op's finances and the Senate should issue a subpoena requiring Miller and Jennings to appear.

Then-Gov. Steve Beshear,
discussing health reform at the
Brookings Institution in D.C.
Prim, Beshear's spokeswoman, said, "While it is unfortunate the co-op did not succeed, an overwhelming majority of Kentuckians have a positive view of Kynect," the online exchange where Kentuckians can buy federally subsidized health-insurance policies. "It has succeeded by providing low-cost health insurance options and creating a competitive marketplace for private insurers that have kept rates low for everyone."

In his speech, Alvarado incorrectly referred to Kynect policies as Medicaid, the federal-state health plan for the poor and disabled. Beshear expanded Medicaid eligibility to Kentuckians in households with incomes up to 138 percent of the federal poverty level.

Alvarado declined to give Kentucky Health News the documents to which he referred in his speech, saying he got them from Bevin's office, which could be asked for them.

Bevin's office provided the liquidators' first report, filed Dec. 31; an actuarial report on small-group plans for 2016, submitted in July 2015; an actuarial report on individual plans for 2015, filed in August 2014; and a February 2015 letter from Miller responding to the Insurance Department's request for a "corrective action plan." None of the documents mention the meetings Alvarado said occurred among CMS, the co-op and the governor's office.

The August 2014 actuarial report said, "The financial viability of KHC is in question. . . . KHC's projections reflect very aggressive assumptions, albeit within a reasonable range, and may result in a very optimistic view of future experience."

The co-op's members used medical services more often than it expected. In the second quarter, there were 263 hospital patient days per 1,000 members, higher than the pricing assumption of 184 per 1,000 but a still a "significant decrease" from the first quarter, for which the report did not give a figure.

The co-op was also having trouble dealing with members and health-care providers. Its corrective plan filed in February 2015 addressed complaints about such things as slow payment standards, paid premiums not being posted to members' accounts, complaints from in-network providers about being processed as out-of-network, and long waits for customer service, with supervisors not being available.

The liquidators' report to the court estimated that the co-op still owes about $80 million in claims, and their financial analysis left unclear whether all those claims would be paid. The balance sheet in the liquidators' statement, dated June 30, said the co-op had $117 million in assets and $128 million in liabilities, and the liabilities included only $67.7 million in unpaid claims. However, the co-op's biggest federal loan, of $125 million, is "subordinate to policyholder obligations, claimant and beneficiary claims, operating expenses and state reserve and solvency requirements," the report said. CMS, the federal agency, has asked an independent actuary to provide its own estimate of unpaid claims.

Thursday, 11 June 2015

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

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."

Wednesday, 27 May 2015

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

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.

Thursday, 30 April 2015

Princess Health andBaptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort.Princessiccia

Baptist Health has become the first stand-alone health-care provider to sign on as a founding partner in Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Baptist will work with SOAR to develop and implement health and education initiatives for residents of Appalachian Kentucky and has committed $150,000 to the initiative over the next three years, the organizations said in a press release.

�Baptist Health understands Eastern Kentucky because we have a proven and time-honored commitment to the health and well-being of our people,� Stephen C. Hanson, chief executive officer of Baptist Health, said in the press release. �Our participation in SOAR reflects this pledge. Besides Richmond, we�ve also got hospitals in Corbin and Lexington, along with outpatient facilities, doctors� offices and other services all over Eastern Kentucky, the rest of the commonwealth and indeed throughout the region."

The University of Kentucky was the first founding sponsor of SOAR, pledging $300,000 over the next three years and winning the right to use the UK HealthCare brand on SOAR materials as well as the university's general logo.

Gov. Steve Beshear and Congressman Hal Rogers formed SOAR in the fall of 2013 to create strategic plans to improve Eastern Kentucky's economy and quality of life.

�Our primary objective is creating and maintaining jobs across eastern Kentucky, and in order to do that, we need a healthy and well-educated workforce,� Beshear said in the release. �I�m pleased that Baptist Health understands the key connections among our efforts and the critical role that health will play in the future of this region."

Thursday, 24 April 2014

Princess Health and Princess Health andPoll: Kentuckians still oppose Obamacare, but favor fixes, not repeal, and think state insurance exchange works well.Princessiccia

Most Kentuckians still oppose the federal health-reform law, but think it should be changed rather than repealed, and most think the state health-insurance exchange created under the law is working well. So says a poll taken for The New York Times and the Kaiser Family Foundation in four Southern states with key U.S. Senate races this year: Arkansas, Kentucky, Louisiana and North Carolina.

"Debate over the law is expected to dominate the midterm elections. Attacks on the law are featuring prominently in campaigns across the country, and Republican lawmakers have continued to push for the law�s replacement," Sabrina Tavernise and Allison Kopicki write. "Questions about it may evoke associations with an unpopular president, the remoteness of Washington from ordinary Americans and extra costs in family budgets. But majorities say they do not want it taken away, even in states that lean Republican in presidential elections."

Among the four states, Kentucky is the only one that is running its own exchange, and the only one in which a majority said it is working well. In Arkansas, which has a combined state-federal exchange, a plurality said it was working well. The other two states use the federal exchange, which had a troubled rollout.

Kentucky is the only Southern state that created its own exchange and expanded Medicaid to include people in households with incomes up to 138 percent of the federal poverty level. The poll found support for Medicaid expansion in all four states, and 55 percent in Kentucky gave Gov. Steve Beshear, who made both decisions, a positive job rating.

The poll, done with landline and cellphone interviews April 8-15, has a margin of sampling error of plus or minus 4 percentage points in each state. (Read more)

Saturday, 5 April 2014

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

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.

Thursday, 18 April 2013

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."

Tuesday, 9 April 2013

Princess Health and Lawsuit alleges state health insurance exchange is unauthorized.Princessiccia

Princess Health and Lawsuit alleges state health insurance exchange is unauthorized.Princessiccia

Tea Party activist David Adams filed a lawsuit Monday challenging Gov. Steve Beshear's legal authority to create Kentucky's health insurance exchange without approval from the General Assembly. The governor created the exchange by executive order to offer health insurance plans for Kentuckians under federal health reform, but did not ask the legislature to approve it.

Adams claims state law requires the exchange to get legislative approval, and he seeks an injunction against it. The law allows the governor to temporarily reorganize units of state government and calls for them to be approved by the General Assembly.

Beshear's office says he exercised his constitutional authority to meet the requirements of federal law, reports Jack Brammer of the Lexington Herald-Leader.

Adams said in a telephone interview, "There is nothing in the constitution that allows him to set up a new bureaucracy that taxes, gains fees or spends money without legislative approval." He added, "This isn't about politics. It is simply about gubernatorial authority in the absence of legislative approval."

Kentucky has received about $250 million from the federal government to cover the initial costs of exchange, but Adams said that is being spent rather quickly and funds will be exhausted by 2014, he said. The state will be responsible for all funding for the exchange beginning in 2015; it plans to fund it with fees from participating insurance companies.

Kentucky is one of 17 states that the federal government approved to build its own exchange, which will be operated by the Cabinet for Health and Family Services and is expected to help insure more than 600,000 Kentuckians. (Read more)

Friday, 5 April 2013

Princess Health and Beshear vetoes prompt-pay bill but takes several steps to address problems in Medicaid; he and Haynes say it's working.Princessiccia

Princess Health and Beshear vetoes prompt-pay bill but takes several steps to address problems in Medicaid; he and Haynes say it's working.Princessiccia

Gov. Steve Beshear has vetoed the bill designed to make Medicaid managed-care firms pay health-care providers more quickly, but is taking administrative steps to address the issue.

Beshear said he agreed with the intent of House Bill 5 but it might have interfered with the contractual relationship between the state and the four managed-care companies. The bill would have subjected that relationship to the state Department of Insurance's review and investigation process for private-insurance payment complaints. 


"That language would have resulted in excessive costs for state government and taxpayers due to the expansion of the review process beyond the current parameters used for private insurance," Beshear's office said in a press release.

Instead, Beshear ordered the department to take over responsibility for review of prompt-payment complaints from the Department for Medicaid Services. "If improper payment practices are discovered, DOI can impose sanctions," the release said. He also ordered the department to audit each of the managed-care firms operating statewide � Wellcare, Coventry Cares, and Kentucky Spirit � at their cost.


Meanwhile, the firms have agreed to meet with every hospital they have under contract to reconcile outstanding accounts.  "This effort will begin immediately and continue until every hospital�s accounts receivable has been reconciled," the release said.  "The results will . . . be made public, in order to provide transparency and accountability." The firms have  agreed to meet with any other provider who wants a meeting.


Also, the Cabinet for Health and Family Services will hold eight regional forums for providers, managed-care firms, and Insurance Department representatives to discuss concerns and how to improve the system. Part of this effort will focus on "emergency room management that meets community needs without an ER operating as a de facto primary-care office," the release said. "A key component of controlling costs and improving health in a healthcare system is to provide the right treatment in the most cost-effective setting."

CHFS Secretary Audrey Tayse Haynes said the switch to managed care, made in November 2011, is working. �We are already seeing a tremendous increase in the use of preventive services, which improve health-care outcomes, while also reducing the enormous costs for treating chronic health conditions� such as diabetes-related amputations, she said.


Beshear said his plan would solve "lingering implementation problems" with managed care "while preserving the significant improvements in patient care and health care cost savings."


"Getting our people healthy and keeping them that way is not just good health policy, it�s good economics," Beshear said. "That�s why we will never return to the old fee-for-service system.  This is a significant cultural shift in medical care that has already happened across the country in both the private insurance market and in the Medicaid system."



Thursday, 28 March 2013

Princess Health and Will Kentucky expand Medicaid, and if so, how?.Princessiccia

By Molly Burchett
Kentucky Health News

Kentucky is one of the last states to decide whether to expand Medicaid under federal health reform, and now that the General Assembly has gone home, Democratic Gov. Steve Beshear can turn his attention to the many questions that linger. Some Republican legislators think he will expand the program, but they worry about the cost when the state would have to start helping cover the new expenses, beginning in 2017.

Republican Gov. Bill Haslam of Tennessee decided Wednesday that he will not pursue Medicaid expansion, saying that it could put hospitals in financial jeopardy by giving them more patients on which they lose money, reports Michelle Kaske of Bloomberg. If he is right and the same logic applies to Kentucky, Medicaid expansion in the state could harm the rural hospitals and providers -- some of whom are already squeezed by the issues with the new managed-care system.

Along with Kentucky, 10 other states are undecided about Medicaid expansion: Alaska, Indiana, Kansas, Nebraska, New York, Oregon, Utah, Virginia, West Virginia and Wyoming. The map by The Advisory Board Company shows the lay of the land; for an interactive picture that outlines the research behind the map, click here.?????
Red=Not participating; Pink=Leaning toward not participating;
Gray=Undecided; Blue=Participating; Light Blue=Leaning toward participating
Only three states with Democratic governors are undecided; 18 Republican governors have rejected expansion. Kentucky is shown as leaning for it because Beshear has repeatedly said that he will expand Medicaid if the state can afford it. He has also mentioned that the state can reserve the right to pull out of the deal in 2017, when it must paying 3 percent of the cost of covering the newly insured, reaching 10 percent in 2020. Still, the questions about cost and affordability remain, and Beshear could be considering another option.

Tennessee has joined Ohio and Arkansas in negotiating with the Obama administration over plans to use federal Medicaid money to purchase private insurance for those who can't afford it but don't qualify for Medicaid now. However, Haslam's plan has been held up because the administration placed too many conditions on the money, writes Kaske. Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in this option since Gov. Mike Beebe of Arkansas, a Democrat, ignited the wildfire of creating a hybrid of the two alternatives, reports Robert Pear of The New York Times.

The idea of privatizing Medicaid expansion appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid. However, many Kentucky hospitals and providers are concerned about the managed-care program that is run by three private organizations, and are calling for immediate action. Beshear has not said whether he will sign or veto a bill that would subject the managed-care firms to the prompt-payments and dispute-resolution rules of the state Department of Insurance.

"Action is needed to address the problems that patients and hospitals are experiencing with Medicaid managed care and to make the system work properly," wrote Harold "Bud" Warman, chair of the Kentucky Hospital Association, and Charles Lovell, chair-elect of the association, in a recent Herald-Leader article that laid out the various problems with the system. "And with the possibility that Medicaid will be expanded in Kentucky to include an additional 350,000 people, it is critical that these issues be addressed right away to avoid even greater problems in the future."

Either using federal dollars to buy private insurance in order to cover newly qualified individuals (the hybrid plan) under the health law's expansion  or expanding in the "traditional" way will not change the current managed care structure of Medicaid in Kentucky. Yet, it would mean that 350,000 more Kentuckians would be covered under managed care; Medicaid would cover those earning up to 138 percent of the federal poverty level, currently up to $15,856 a year for an individual.

The money that the federal government offers for expansion is very tempting. The question then may be, how will it be used?

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Tuesday, 26 March 2013

Princess Health and Senate sends bill for prompt payment by managed-care firms to Beshear, who won't say whether he will sign or veto it.Princessiccia

Princess Health and Senate sends bill for prompt payment by managed-care firms to Beshear, who won't say whether he will sign or veto it.Princessiccia

A bill aimed at resolving payment disputes between medical providers and Medicaid managed-care companies passed unanimously Monday in the Senate, and has been sent to Gov. Steve Beshear for his consideration.

House Bill 5, sponsored by House Speaker Greg Stumbo, D-Prestonsburg, would apply existing prompt-payment laws to managed-care firms and would set up an appeal process in the Department of Insurance to handle disputes between them and medical providers. Those claims are now handled by the Cabinet for Health and Family Services, which administers Medicaid and has had some problems with the bill.

Hospitals, doctors and other health-care providers have complained that the cabinet is not resolving their payment disputes with managed-care firms, putting many rural hospitals, clinics and health departments in serious financial binds.  Mental health centers have also reported cutting back services.

Asked last night what he would do with the bill, Beshear said the cabinet "has worked with the managed-care organizations and health-care providers to reduce problems during the change, and many concerns have been addressed.  However, I recognize that some issues persist.  I will review this bill carefully.�

Beshear has 10 days, excluding Sundays, to decide whether to veto the bill, sign it into law or allow it to become law without his signature. Stumbo said that if bill is vetoed it would likely be House Bill 1 in the 2014 session, reports Jessie Halladay of The Courier-Journal. The bill is a top priority for many health-care providers.

Friday, 15 February 2013

Princess Health and Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban.Princessiccia

Princess Health and Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban.Princessiccia

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.


Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Wednesday, 6 February 2013

Princess Health and Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban.Princessiccia

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies � more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.