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

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

advertising cigarettes General Assembly governor health policy legislature local government politics smoking smoking ban smoking bans smoking ordinances tobacco tobacco prevention

Gusty 19:04 Add Comment

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.'

Princess Health and It Has Come to This? - Donald Trump's "Truly Absurd," "Word Salad," "Gibberish" Health Care Policy. Princessiccia

Princess Health and It Has Come to This? - Donald Trump's "Truly Absurd," "Word Salad," "Gibberish" Health Care Policy. Princessiccia

deception health care reform health policy politics ppaca propaganda

Gusty 12:07 Add Comment

Health Care Renewal is officially non-partisan.  We do not endorse candidates for office, or political parties.  That does not prevent us from commenting on policy issues, and on pronouncements and actions by politicians and government officials when they relate to the issues that interest us.

So, we have criticized excessive coziness among politicians and government officials on one hand, and big health care organizations and their leaders on the other.  We have noted conflicts of interest affecting politicians, particularly the revolving door, and other shadings towards corporatism.  We have noted how health care policy discussions may focus on health care financing, while ignoring some of the bigger issues we discuss  (For example, see our discussions of health care reform, and particularly this one of the then new US Affordable Care Act). These include: leadership of health care organizations by generic managers (managerialists) who are unsympathetic or even hostile to the health care mission; deceptive practices involving marketing, the manipulation and suppression of research, stealth health policy advocacy, stealth lobbying, etc; and timidity in regulation and law enforcement, leading to outright impunity of health care leaders.

We have criticized politicians and government leaders of all parties and from all sides of the political spectrum.  For example, in retrospect we criticized the (Democratic) Clinton administration's laissez faire attitude to conflicts of interest at the National Institutes of Health (see summary here and links to older posts).  We criticized flagrant examples of the revolving door involving top Bush adminstration officials (e.g., most recently here), and yet more involving Obama administration officials (e.g., most recently here).

Yet we also acknowledge that most policy discussions by political and government figures are at least well-intended and based in some degree on the facts and knowledge of the health care context (even if we think the results might be misguided, wrong-headed, or tangential.)  So, while health care is not so far the most important issue in the tumultuous 2016 US presidential race, there has been considerable discussion of it.  Most major candidates have staked out health care positions that again appear well-intended and based to some degree on the facts and context (although my point is not to comment on their merits.)

But there has been one major exception. 

The Leading Candidate with No Health Care Plan

Donald Trump currently seems to be the leading Republican presidential candidate.  As reported by the Minnesota Post,

Trump doesn�t have a health care plan. Go to the issues section of his campaign. Really, go there, you won�t believe what you see. A typical campaign website has position papers. Trump has none. The link to 'Issues' takes you to a pretty frightening page of short embedded videos of Trump himself summarizing his positions at a level of detail that you should find insulting.

But he doesn�t even have one of those on health care.

In addition to 'Issues,' the site�s homepage has a pulldown menu called 'Positions.' I don�t get the difference, but who cares? �Positions� are actual written-out position statements, not videos, but only on five issues, none of which are remotely related to health care (nor many other major issues).

So for Trump�s health-care thinking, we have to rely on what he says in debates and speeches and, I suppose, tweets, some of which have been controversial.

The Candidate with No Health Care Policy Advisers

On February 20, 2016, Politico reported that Mr Trump's campaign also apparently has no health policy advisers.  The article noted that Mr Trump had written in one of his books that he would

Lock the best health care policy minds in a room � and don�t let them out until they�ve crafted a plan for providing terrific coverage for everyone.

But he has not said who those advisers might be.  Furthermore, the reporter was unable to determine who, if anyone, is currently advising Mr Trump about health care,

Sam Clovis, Trump�s national policy adviser, insists the campaign is talking with lots of health care experts � but declined to name any of those advisers.

'We have experts around the world who help us on these various topics,' Clovis said in an interview with POLITICO. 'We get very frank and honest input if we do not expose these people to the scrutiny of the press. � As we get further along they might want to come out of the shadows.'

However,

POLITICO scoured the landscape of notable policy wonks � from academics to lobbyists to congressional staffers to think tank fellows � but was unable to find anyone, on either side of the political divide, who acknowledged whispering health care policy tips in the billionaire�s ear. Or for that matter, of hearing of anyone who had talked to his campaign.

'He seems to be a one-man policy shop,' said Michael Cannon, director of health policy studies at the libertarian Cato Institute, and a leading critic of Obamacare.

So Mr Trump has no clear health care plan, and apparently no health care advisers.  Furthermore, reports of what this candidate has said about health care reveals some anomalies, to say the least.

Reducing Pharmaceutical Costs to Zero?

The Washington Post in a "Fact Checker" feature on February 18, 2016, entitled, "Trump�s truly absurd claim he would save $300 billion a year on prescription drugs," quoted Mr Trump three times on the costs of pharmaceuticals,

'We are not allowed to negotiate drug prices. Can you believe it? We pay about $300 billion more than we are supposed to, than if we negotiated the price. So there�s $300 billion on day one we solve.' �Donald Trump, remarks at Plymouth State University, Holderness, N.H., Feb. 7, 2016

'So I said to myself wow, let me do some numbers. If we competitively bid drugs in the United States, we can save as much as $300 billion a year.' �Trump, remarks in Manchester, N.H., Feb. 8

'We�re the largest drug buyer in the world. We don�t negotiate. We don�t negotiate. You pay practically the same for the country as if you go into a drug store and buy the drugs. If we negotiated the price of drugs, Joe, we�d save $300 billion a year.' �Trump, interview on MSNBC, Feb. 17

The problem here is that the $300 billion figure turns out to be ridiculous.  The Post article noted,

To put Trump�s $300-billion-a-year claim in perspective, let�s first note that Sanders cites a 2013 estimate from the Center for Economic and Policy Research that negotiated drug prices would result in savings to Medicare of between $230 billion to $541 billion over 10 years.

So for virtually the same policy, Sanders is claiming savings averaging $38 billion a year � and Trump is promising a figure eight times larger. (Clinton offers no estimated savings.)

What�s going on here? It�s unclear, because as usual the Trump campaign refuses to respond to any queries about Trump�s numbers.

Furthermore,

total spending in Medicare Part D (prescription drugs) in 2014 was $78 billion. So Trump, in effect, is claiming to save $300 billion a year on a $78 billion program. That�s like turning water into wine.

Finally,

It�s possible that Trump is being sloppy and when he discusses Medicare, he really means to say he would force government-led pricing on all prescription drugs. But the numbers don�t add up that way either.

In fact, depending on the source you consult, total annual spending on prescription drugs in the United States is between $298 billion a year to $423 billion. So that would mean Trump is claiming that he can eliminate virtually any cost to prescription drugs. It would suddenly be free!

So Mr Trump's claims made on at least three occasions about the magnitude of savings that would result from his (unoriginal) proposal to have the government negotiate drug prices were mathematically implausible, if not impossible. 

"Word Salad" about the Mandate

Rather right-wing columnist Jennifer Rubin, writing in the Washington Post on February 22, 2016, provided two sets of quotes from interviews with Mr Trump about his position on the "mandate" within the Affordable Care Act (ACA).  Note that the mandate imposes a (relatively modest) extra tax on people who do not have health insurance, providing an incentive to have such insurance.  For example, on "Meet the Press,"

DONALD TRUMP: Well, on the mandate, if you look at the mandate, we had a situation where we were, Anderson Cooper, who�s terrific, by the way, and did a terrific job, but we were talking over each other. Look, I want, we�re going to repeal and replace Obamacare. Obamacare is a total and complete disaster. It�s going to be gone. We�re going to come up with a great healthcare plan, whether it�s healthcare savings accounts, we have a lot of different things. We�re going to get rid of the lines between states, we�re going to have great competitive bidding. But I say all the time, you can call it anything you want. People are not going to die in the middle of the street. People are not going to die on the sidewalk if I�m president, okay?

CHUCK TODD: Well, let me get something definitive from you on this.

DONALD TRUMP: But Chuck, I say that, excuse me, I say that to packed houses with thousands and thousands of people, Republicans mostly, and I get standing ovations. I�m not going to let that happen. If I�m president, we�re not going to have people dying on the streets. So you can call it whatever you want. I don�t call it a mandate, I just say it�s common sense.

CHUCK TODD: No, I understand that. Well, let me ask you this. Do you think that it should be a law that anybody who can afford health insurance has to have it?

DONALD TRUMP: I think, no, I think it�s going to be up to them, okay? I want it to be up to them. But I�m really talking about people that can�t afford it. We�re not going to let people die in squalor because we are Republicans, okay? That�s part of the problem with the Republicans, where somehow they got fed into this horrible position. We�re going to take care of people. But no, people don�t have to have it. We�re going to have great plans, they�re going to be a lot less expensive than Obamacare. They�re going to be private. There are going to be lots of different options. We�re going to have a lot of different options. Right now you have no options. You know why? Because the insurance company controlled Obama because they gave him a lot of money. That�s why you have lines around the states. And you can�t get competitive bidding.

Her summary was:

He insists whatever inanity he said earlier was a mistake, denies he took or takes a liberal position and declares there will not be people 'dying in the streets.' (Does he understand there is a duty now to treat people, but what we are debating is insurance?) Then he ends with assurances he is loved by crowds. Superlatives by the bushel may be funny, but they also substitute for concrete answers. It may seem like a word salad or stream of consciousness at first glance, but it is a salad he tosses up over and over again, each time avoiding close scrutiny.

An article on February 22, 2016, in the left leaning MotherJones stated that Mr Trump had already contradicted his previous approval of the "mandate,"

Trump has now made clear that he doesn't like the individual mandate after all�he just misspoke when he said that to Anderson Cooper a few days ago.

So while Mr Trump has drawn attention to his position on the mandate, that position seems hopelessly incoherent, or as Ms Rubin called it, "word salad."

More "Gibberish"

The Minnesota Post article also noted,

When asked Thursday night under Rubio�s prodding to describe his plan for health care, he said, as he always does, that he wants to repeal the Affordable Care Act and replace it with something 'much better.' Then he says (and this is a direct quote from the debate transcript): 'I want to keep pre-existing conditions. I think we need it. I think it�s a modern age. And I think we have to have it.' This is gibberish, especially the explanation that 'I think it�s a modern age,' which may have some meaning but I can�t imagine what.

In addition, in the most recent debate, Mr Trump did emphasize that he wanted insurance companies to be able to sell policies across state lines, although his wording was not so clear,

That weird and confusing phrasing � about 'getting rid of the lines around the states,' which Rubio mocked � as best as anyone can tell means that Trump wants national health insurers to be able to offer standardized plans all over the country, instead of having to meet the particular standards and requirements imposed by individual states. Different states require different things of health insurers, which prevents national firms from offering plans in all states.

As the article noted, this is not a new idea, and how much difference this change would make is not clear. Nonetheless, even after being badgered repeatedly, Mr Trump could not add more substance to his health care plan, nor explain how he might get more substance.

With Rubio pressing in and badgering Trump from the sidelines � the same way Rubio was badgered a few weeks ago by Chris Christie and the way Trump often badgers other candidates � and with CNN�s Dana Bash following up, Trump said his three things: Repeal Obamacare and replace it with something much better, get rid of the lines around the states, and don�t let people die in streets. I always assumed that there was more to his plan, but I never came across the details. And, during the exchange Thursday night, it came out that there is no more. Here�s that chunk of the transcript so you can decide for yourself if I�m missing something. (I�ve done a tiny bit of editing for flow.)[italics added for emphasis- Ed]

BASH: Mr. Trump, Senator Rubio just said that you support the individual mandate. Would you respond?

TRUMP: I just want to say, I agree with that 100 percent, except pre-existing conditions, I would absolutely get rid of Obamacare. We�re going to have something much better, but pre-existing conditions, when I�m referring to that, and I was referring to that very strongly on the show with Anderson Cooper, I want to keep pre-existing conditions. I think we need it. I think it�s a modern age. And I think we have to have it. (APPLAUSE)

BASH: OK, so let�s talk about pre-existing conditions. What the insurance companies say is that the only way that they can cover people [who have pre-existing conditions and would be more expensive to cover] is to have a mandate requiring everybody purchase health insurance. Are they wrong?

TRUMP: I think they�re wrong 100 percent. What we need � look, the insurance companies take care of the politicians. The insurance companies get what they want. We should have gotten rid of the lines around each state so we can have real competition. We thought that was gone, we thought those lines were going to be gone, so something happened at the last moment where Obamacare got approved, and all of that was thrown out the window.

The reason is some of the people in the audience are insurance people and insurance lobbyists and special interests. They got � I�m not going to point to these gentlemen, of course, they�re part of the problem, other than Ben [Carson], in all fairness. And, actually, the governor [John Kasich], too. Let�s just talk about these two, OK? Because I don�t think the governor had too much to do with this.

But, we should have gotten rid of the borders, we should have gotten rid of the lines around the states so there�s great competition. The insurance companies are making a fortune on every single thing they do. I�m self-funding my campaign. I�m the only one in either party self-funding my campaign. I�m going to do what�s right. We have to get rid of the lines around the states so that there�s serious, serious competition. And you�re going to see � excuse me. You�re going to see pre-existing conditions and everything else be part of it, but the price will be down, and the insurance companies can pay. Right now they�re making a fortune. (APPLAUSE)

BASH: But just to be specific here, what you�re saying is getting rid of the barriers between states, that is going to solve the problem...

TRUMP: That�s going to solve the problem. And the insurance companies are going to say that they want to keep it. They want to say � they say whatever they have to say to keep it the way it is. I know the insurance companies, they�re friends of mine. The top guys, they�re friends of mine. I shouldn�t tell you guys, you�ll say it�s terrible, I have a conflict of interest. They�re friends of mine, there�s some right in the audience. One of them was just waving to me, he was laughing and smiling. He�s not laughing so much anymore. Hi.
Look, the insurance companies are making an absolute fortune. Yes, they will keep pre-existing conditions, and that would be a great thing. Get rid of Obamacare, we�ll come up with new plans. But we should keep pre-existing conditions.

RUBIO: Dana, I was mentioned in his response, so if I may about the insurance companies...

BASH: Go ahead.

RUBIO: You may not be aware of this, Donald, because you don�t follow this stuff very closely, but here�s what happened. When they passed Obamacare they put a bailout fund in Obamacare. All these lobbyists you keep talking about, they put a bailout fund in the law that would allow public money to be used, taxpayer money, to bail out companies when they lost money. And we led the effort and wiped out that bailout fund. The insurance companies are not in favor of me, they hate that. They�re suing right now to get that bailout money put back in.

Here�s what you didn�t hear in that answer, and this is important, guys, this is an important thing. What is your plan? I understand the lines around the state, whatever that means. This is not a game where you draw maps...

TRUMP:...And you don�t know what it means?

RUBIO: What is your plan, Mr. Trump? What is your plan on health care?

TRUMP: You don�t know. The biggest problem...

RUBIO: ...What�s your plan?

TRUMP: ... You know, I watched him melt down two weeks ago with Chris Christie. I got to tell you, the biggest problem he�s got is he really doesn�t know about the lines. The biggest thing we�ve got, and the reason we�ve got no competition, is because we have lines around the state, and you have essentially....

RUBIO: ...You already mentioned that [inaudible] plan. I know what that is, but what else is part of your plan?...

TRUMP: ...You don�t know much...

RUBIO: ...So, you�re only thing is to get rid of the lines around the states. What else is part of your health-care plan?...

TRUMP: ...The lines around the states...

RUBIO: ...That�s your only plan...

TRUMP ... Excuse me. Excuse me.

RUBIO: ... His plan. That was the plan?...

TRUMP:...You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York or Texas, you�ll have many. They�ll compete, and it�ll be a beautiful thing.

RUBIO: Alright...So that�s the only part of the plan? Just the lines?

TRUMP: The nice part of the plan � you�ll have many different plans. You�ll have competition, you�ll have so many different plans.

RUBIO: Now he�s repeating himself.

TRUMP: No, no, no. I watched him repeat himself five times four weeks ago...

RUBIO:... I just watched you repeat yourself five times five seconds ago...

TRUMP: I watched him meltdown on the stage like that, I�ve never seen it in anybody...

BASH:...Let�s stay focused on the subject...

TRUMP:...I thought he came out of the swimming pool...

RUBIO:...I see him repeat himself every night, he says five things: Everyone�s dumb, he�s gonna make America great again...We�re going to win, win win. He�s winning in the polls...And the lines around the state. (APPLAUSE)

BASH: Senator Rubio, you will have time to respond if you would just let Mr. Trump respond to what you�ve just posed to him...

RUBIO: ... Yeah, he�s going to give us his plan now, right? OK...

BASH [to Trump]:...If you could talk a little bit more about your plan. I know you talked about...Can you be a little specific?...

TRUMP: ... We�re going to have many different plans because... competition...

RUBIO: ... He�s done it again.

TRUMP: There is going to be competition among all of the states, and the insurance companies. They�re going to have many, many different plans.

BASH: Is there anything else you would like to add to that...

TRUMP: No, there�s nothing to add. What is to add?

After being repeatedly asked about the substance of his health care policy agenda, Mr Trump only seems to have repeated the notion of selling health insurance across state lines to increase competition, interrupted by non sequiturs insulting Senator Rubio and insurance executives.  The Minnesota Post writer and I could find absolutely no other content in Mr Trump's , despite repeated inquiries about the substance of his health care plan.

It does seem reasonable to describe Mr Trump's health care policy ideas as gibberish.

Summary 

Health care and public health affect all Americans, and all people around the world.  Health care in the US is more expensive and less accessible than it is in many other developed countries.  For all the money the country spends, there is no clear evidence that the quality of patient care, or patients' outcomes are better than, or sometimes even comparable to those of other countries  The reforms embodied in the Affordable Care Act (ACA, PPACA, "Obamacare') have increased the proportion of insured patients, but insurance remains expensive for many, and insurance coverage now often has major gaps that mean a major illness can bankrupt a middle-class patient.

Furthermore, the law has done nothing to reduce concentration of power in health care.  It has done nothing to make health care leaders more accountable, especially for their organization's unethical or even criminal behavior, decrease their ability to line their pockets regardless of such behavior, and thus reduce their impunity.  It will not obviously decrease conflicts of interest affecting those who make decisions about patient care or health policy, lock the revolving door between government and the health care industry, end manipulation of clinical research to serve vested interests, or suppression of research whose results offend such interests, etc, etc.

So health care policy is increasingly important, and increasingly demands serious discussion.  A US presidential campaign ought to provide some impetus for such discussion, although health care policy is certainly not the only thing that needs to be discussed.

Most presidential candidates have at least attempted a serious discussion of health policy, if not in person, then in position papers or on their web-sites.

However, the currently leading candidate for the Republican nomination does not seem to have serious ideas about health care. Yet he has said "We�re going to come up with a great healthcare plan."  To substantiate such claims, he has repeated a few vague talking points, and when challenged, seems unable to manage any substantive conversation beyond them.  Some of his verbal pronouncements have been nothing short of ridiculous.  

"in the big lie there is always a certain force of credibility...." said a 20th century world leader who inspired adulation, and led to disaster.  

We live in perilous times when a candidate with such reckless approaches to critical problems continues to attract adulation.

ADDENDUM (29 February, 2016) - This post was republished on the Naked Capitalism blog on February 28, 2016.  

ADDENDUM (1 March, 2016) - This post was republished on OpEdNews on February 29, 2016.

Princess Health and Annual health policy forum set Sept. 28 in Bowling Green.Princessiccia

Princess Health and Annual health policy forum set Sept. 28 in Bowling Green.Princessiccia

education food Foundation for a Healthy Kentucky foundations health education health policy housing nutrition philanthropy schools transportation workplace health

Gusty 19:58 Add Comment

This year's annual Howard L. Bost Health Policy Forum "will offer new insights and opportunities from a range of civic sectors for a shared vision, policies, and actions for community health," says its lead sponsor, the Foundation for a Healthy Kentucky.

"Local, regional, and national speakers will share their knowledge and experiences in building healthy communities, with a focus on transportation and housing, education, food systems and policy, and employers and workplaces," the foundation says. "TED style" speakers will make presentations on each of the forum's four focus areas: education, food systems and policy, employer/workplace, and transportation/housing.

The forum will be held at the Sloan Convention Center in Bowling Green on Monday, Sept. 28. For the registration website, click here.

Princess Health and University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health.Princessiccia

Princess Health and University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health.Princessiccia

Foundation for a Healthy Kentucky health policy rural health University of Kentucky

Gusty 07:29 Add Comment

University of Kentucky College of Public Health Professor Ty Borders was recently appointed to the National Advisory Committee on Rural Health and Human Services.

Ty Borders

This committee is part of the Health Resources and Services Administration and includes a 21-member panel of nationally recognized rural health experts that is responsible for making recommendations to the Department of Health and Human Services on issues related to rural health. Borders's appointment will continue until April 2019.

�This appointment is an honor not only for Dr. Borders and his family, but also for Kentucky,� Rep. Andy Barr, R-Ky., said in a UK news release. �Dr. Borders possesses a broad and deep understanding of the health care challenges facing rural Kentucky and America. His unique insight about evidence-based strategies that could improve rural health and health care delivery will greatly benefit the committee.�

Borders is the chair of the Department of Health Services Management and the Foundation for a Healthy Kentucky endowed chair in Rural Health Policy. He also serves as a founding co-director of the UK Institute for Rural Health Policy and is the editor of the Journal of Rural Health, an academic publication devoted to rural health research.

Princess Health andElectronic cigarettes are 'high on every school system's radar right now,' Western Ky. school official tells Henderson newspaper.Princessiccia

Princess Health andElectronic cigarettes are 'high on every school system's radar right now,' Western Ky. school official tells Henderson newspaper.Princessiccia

e-cigarettes electronic cigarettes health policy school health schools smoking

Gusty 11:46 Add Comment

This story has been updated to reflect recent data about teens and e-cigarette use.

School officials in northwestern Kentucky are trying deal with an increase in the use of electronic cigarettes by students, Erin Schmitt reports for The Gleaner in Henderson.

Union County Schools spokeswoman Malinda Beauchamp told Schmitt there had been 16 discipline referrals of students using e-cigarettes at Union County High School and 26 at Union County Middle School this year. There is no data from previous years for comparison, but school officials "have noticed the rise" and want to be proactive in preventing more usage, Beauchamp said.

Schmitt reported on e-cigarette usage at other schools in the region and found 15 to 20 incidents at Henderson County High, but only a few incidents in North Middle School, South Middle School and Central Academy, according to Julie Wischer, public information officer for Henderson County Schools.

The Webster County Schools did not have exact numbers of incidents of usage, but has e-cigarettes listed under its policy as a tobacco product or paraphernalia, Todd Marshall, Webster�s director of pupil personnel, told Schmidt. Though it�s a new issue, Marshall said, �It�s high on every school system�s radar right now.�

A recent report by the Centers for Disease Control and Prevention found that the number of high school students who tried e-cigarettes has tripled in one year, to more than 13 percent, while smoking of traditional cigarettes dropped to 9.2 percent from more than 13 percent, CBS News reports.

�Many users of marijuana prefer e-cigs or vapes because it�s smokeless, odorless and easy to hide or conceal,� Henderson County Supt. Patricia Sheffer told Schmitt. �This �vaping� is a concern in our schools and elsewhere among youth, because it can produce a nearly instant �high� with little or no detection."

The preventive measures include: a Facebook message to parents and students from her about the dangers of e-cigarettes, which not only involves nicotine usage, but also marijuana, alcohol and other drugs that can be ingested through the device; updating policies, procedures and the student code of conduct to include prohibitions on e-cigs and vapor devices on school property; a commitment to find out how the student got access to the device; and a required drug and alcohol screening if caught, with parent-paid counseling if the screen is positive.

Princess Health and Princess Health andFoundation for a Healthy Kentucky reports putting 24 percent more money into grants last year than in 2012.Princessiccia

Princess Health and Princess Health andFoundation for a Healthy Kentucky reports putting 24 percent more money into grants last year than in 2012.Princessiccia

cardiovascular disease children's health foundations health policy philanthropy public health schools smoking smoking ban smoking bans smoking ordinances

Gusty 13:33 Add Comment

The Foundation for a Healthy Kentucky made grants totaling $2,355,838 in 2013, a 24 percent increase over the 2012 total of $1,903,660, according to the annual report it released yesterday.

Last year was the first in which the foundation made grants for two major initiatives: Investing in Kentucky's Future, which it calls "a $3 million commitment to seven Kentucky communities where civic leaders have come together and committed to a process and a plan for collective impact on the future health of their children," and Promoting Responsive Health Policy, which tries to see that voices of under-represented populations are part of the health-policy conversation in Kentucky.

The first initiative's seven grantees are Fitness for Life Around Grant County, the Clinton County Schools (for the Healthy Hometown Coalition), the Foundation for Appalachian Kentucky (for the Perry County Health and Wellness Coalition), the Green River Area Development District (for the Partnership for a Healthy McLean County), the Kentucky Heart Foundation (for work in Boyd and Greenup counties), Kentucky River Community Care (for the Breathitt County Health Planning Council for Children) and the Louisville Metro Department of Health and Wellness (for the Coalition for Louisville Youth).

Under the policy initiative, the report says, grantees "are working to improve access to needed health care, support children's health, strengthen local public health and "increase the number of Kentuckians living in communities where workplaces are smoke-free." For a complete list of grants made by the foundation in 2013, click here. For a January press release about them, click here.

The foundation was established in 2001 to settle a lawsuit by then-Attorney General Ben Chandler against Anthem Inc. to recover the charitable assets that Anthem had gained in its merger with the old Kentucky Blue Cross/Blue Shield. The foundation's net assets grew to nearly $56.4 million last year, a 7.7 percent increase over the end of 2012.

The foundation is a non-profit philanthropy with a mission of addressing the unmet health-care needs of Kentuckians. It has invested more than $24 million in health-policy research and pilot-project grants that invests in communities and informs health policy through grant making, research and education. It says it is "committed to improving access to care, reducing health risks and disparities and promoting health equity."

The foundation also acts as a convener, through its annual Howard L. Bost Health Policy Forum, its "Health for a Change" workshops and webinars, funding of conferences held by others and meeting space at its new offices in eastern Jefferson County for more than 21 community and statewide organizations.

It also acts as a communicator, through its annual Kentucky Health Issues Poll and other research, and it funds independent health reporting by Kentucky Educational Television and the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, which publishes Kentucky Health News.

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

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

Congress elections governor health insurance health policy heath reform insurance exchange obamacare politics state government

Gusty 06:47 Add Comment

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)

Princess Health and Princess Health andObama reminds the uninsured of March 31 signup deadline; McConnell continues to point out the pitfalls of reform.Princessiccia

Princess Health and Princess Health andObama reminds the uninsured of March 31 signup deadline; McConnell continues to point out the pitfalls of reform.Princessiccia

health insurance health policy health reform obamacare politics

Gusty 07:31 Add Comment

On the fourth anniversary of the law that has informally come to bear his name, President Obama reminded uninsured Americans that they have only one more week to sign up for coverage under open enrollment.

He also dismissed Republican calls to repeal or replace the law, first citing the relief one woman shared with him after she used her new insurance for the first time: "I felt like a human being again. I felt like I had value."

Obama said, "This is what�s at stake any time anyone, out of some outdated obsession, pledges to repeal or undermine the Affordable Care Act. And that�s why my administration will spend the fifth year of this law and beyond working to implement and improve on it." (Read more)

Senate Republican Leader Mitch McConnell took the anniversary as an opportunity to remind voters of the pitfalls of "a deeply misguided expieriment," noting in an op-ed piece that Obama "pledged that Americans could keep their health care plans and their doctors and that their coverage would be 'more secure and stable' than before" and that journalistic fact-checkers called that "the lie of the year."

McConnell cited the example of Angela Strobel of Owensboro, "a mother of five girls [who] not only lost her insurance, she also lost a trusted family doctor to Obamacare. In a perfect summary of modern liberalism, one of the billing clerks for Kentucky's Obamacare exchange told Angela that since she now qualifies for Medicaid, she'd be breaking the law if she tried to pay more out of her own pocket just to keep her old doctor. Medicaid rules forbid it. The upshot: for Angela and her family, it's either Medicaid or a monthly premium increase of nearly $1,000."

Medicaid is free, but many doctors don't treat Medicaid beneficiaries, and most insurance policies sold through the exchanges have fewer providers to choose from because some providers were not willing to limit their charges in order to be part of the insurance network.

"A recent analysis by the management consulting firm McKinsey & Co. found that only a fraction of the biggest local hospitals in a given coverage area will accept Obamacare patients," McConnell wrote. "An Associated Press study found that only four of the 19 cancer centers it surveyed would give Obamacare patients access to its cancer care through the new Obamacare exchanges in their states. This is progress?" (Read more)

Princess Health and Poll shows strong support for medical marijuana in Kentucky.Princessiccia

Princess Health and Poll shows strong support for medical marijuana in Kentucky.Princessiccia

federal legislation Foundation for a Healthy Kentucky health policy legislation legislature marijuana poll state government; General Assembly

Gusty 07:35 Add Comment

A statewide poll has found that 78 percent of Kentucky adults support the use of marijuana for medicinal purposes if recommended by their doctor, while only 26 percent of favor it for recreational purposes.

There were no significant differences in the poll results among the regions of the state on the medical-marijuana question, but on the recreational-use question, the Louisville area and Northern Kentucky were more likely to favor it, at about 37 percent. For geographic and demographic breakdowns of the poll results, click here.

Nationally, 17 states and the District of Columbia allow medical marijuana, and three states have recently legalized it for recreational use.

�Our Kentucky Health Issues Poll is designed to be informative to Kentucky policymakers,� said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. �Over the past several years, bills dealing with legalization of marijuana have been filed in the Kentucky General Assembly. This research gives policymakers a snapshot of Kentuckians� views on this issue and should be helpful as lawmakers consider issues for the 2014 legislative session.�

For years, Sen. Perry Clark, D-Louisville, has introduced bills in the Kentucky Senate aimed to legalize medical marijuana. Although the bills, referred to as The Gatewood Galbraith Medical Marijuana Memorial Act, gained media coverage in the 2012 and 2013 legislative sessions, they have not received a committee hearing and have not passed.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati and was conducted last year from Sept. 20 to Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 percentage points.

Princess Health and Medicaid expansion could change Kentucky's course, big time.Princessiccia

Princess Health and Medicaid expansion could change Kentucky's course, big time.Princessiccia

Affordable Care Act eonomy health insurance health policy health reform jobs Medicaid Patient Protection and Affordable Care Act politics poverty state government

Gusty 20:57 Add Comment

NEWS ANALYSIS

By Al Cross

Kentucky Health News

"Today we change the course of Kentucky's history."

It is not often that a public official can say such a thing with a large measure of credibility, but Gov. Steve Beshear legitimately raised that hope Thursday, as he announced that he would expand Kentucky's Medicaid program under federal health reform.

Beshear with graph predicting positive impact on budget

If Beshear's vision is fulfilled, Kentucky will no longer have one of the unhealthiest populations of any state, a change that will make it more attractive to employers, and any Kentuckian who wants health insurance will be able to get it.

It is in large measure the realization, in the state where all President Harry Truman's grandparents were born, of his 68-year-old dream of national health insurance. The statue of Truman's vice president, Alben Barkley of Paducah, seemed to shine a little more brightly than usual in the Capitol rotunda as the press-conference crowd dispersed.

But this is a project with many moving parts -- billions of dollars, thousands of health-care providers, hundreds of thousands of Medicaid beneficiaries, and scores of political and bureaucratic decisions -- and much could go wrong.

Skeptics point to the problems with the managed-care Medicaid system that Beshear implemented too hurriedly, apparently to avoid complicating his November 2011 re-election, and argue that the program needs fixing before adding 300,000 new enrollees to the 825,000 already on the rolls. Beshear says he's tackling the problems, the program is "working pretty well" and the managed-care companies can handle the influx.

The skeptics also question whether the state can afford the match for the federal funds. "Broad and vague anxieties," Beshear called them, and he came armed with two studies concluding that expansion would actually gain the state money -- mainly because of the billions it will send to the state's health-care providers, creating more jobs, but also because many of the 300,000 or so newly eligible people are not expected to enroll, based on a Price Waterhouse Coopers study drawing on research by the Congressional Budget Office.

University of Louisville research

Preliminary estimates were that expansion would add 400,000 Kentuckians to the Medicaid rolls. However, the study estimated that only 308,000 will become eligible and that only 188,000 will enroll, thus costing the state much less than some expected when it has to match federal funds beginning in January 2017. The initial match will be 5 percent, rising to 10 percent in 2020. The estimated cost for the newly eligible in fiscal 2020-21 is $151 million, in a state budget that is likely to exceed $10 billion. (The state's current share of Medicaid costs, 29.5 percent, is about $1.5 billion a year.)

Those are just estimates. "I believe reality will dwarf those numbers on the spending side," Tea Party activist David Adams, who says he plans to challenge the plan in court, told reporters. But for the time being at least, Beshear has the numbers on his side, and he said they are "very conservative."

The governor said opponents of the plan "fall back on national politics" and say expansion means that Kentucky, a state that President Obama lost big both times, will be "supporting Obamacare. To them I say, 'Get over it.' . . . I'm going to do what's best for Kentucky's people, period." Asked why so many governors have rejected expansion, he said it was mostly "partisan politics."

Conservative columnist John David Dyche cites an Oregon study saying Medicaid is ineffective, but a Harvard School of Public Health study in three other states showed that expansion of Medicaid improves health and saves lives.

Beshear said the expansion, along with health insurance and subsidies available through a state-run exchange that is also part of health reform, would give the state a healthier workforce because studies show that people with health insurance are less likely to skip exams and let health conditions worsen and become costlier and more difficult to treat. "The lack of early care is one reason that Kentucky's health picture is so horrendous," he said.

Kentucky's workforce is one of the nation's least healthy, and the state has a disproportionate number of working-age people who are not in the workforce because of health problems. The state ranks first in smoking, cancer deaths and preventable hospitalizations; second in heart disease and poor physical-health days; third in heart attacks and poor mental-health days; and in the top 10 in diabetes,  cholesterol and sedentary lifestyles. That hurts the state's image as well as its economy, Beshear said. "There will be a huge economic effect for a healthier Kentucky."

He said most of the newly eligible people are not "freeloaders asking for a handout," but people who are working at jobs without health insurance. He said another 332,000 Kentuckians will get insurance through the state exchange, 276,000 of them with subsidies available to people with incomes up to 400 percent of the poverty level. Without Medicaid expansion, he said, 206,000 would not be eligible for Medicaid or a subsidy, and "We cannot leave those people stranded."

The health-reform law tried to force states into expanding Medicaid, but the U.S. Supreme Court ruled that the states should make the choice without fear of financial penalties. The law calls for expansion to cover people under 65 in households up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

Republicans can do little to stop the expansion. They control the state Senate, but Medicaid eligibility and benefit decisions belong to the executive branch, and even if a bipartisan legislative committee were to block the implementing regulations, Beshear could override it.

Or perhaps we should say he would override it. Emotional at times, Beshear called the move "the single most important decision of our lifetime for improving the health of Kentuckians" but said it was easy to make. As a governor who has failed to win his main campaign promise, expanded gambling, and has had relatively little money to spend because of the Great Recession, this is likely to be his largest legacy.

For details and background from the governor's office, click here. For Beshear's YouTube commentary on the issue, click here.

Princess Health and W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?.Princessiccia

Princess Health and W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?.Princessiccia

breakfast child obesity childhood obesity children children's health education food food security health policy Medicare prevention state government

Gusty 15:47 Add Comment

By Molly Burchett
Kentucky Health News

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America�s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

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.

Princess Health and Feds letting Arkansas privatize Medicaid expansion; idea could spread like wildfire, as in Florida, but cost questions remain.Princessiccia

Princess Health and Feds letting Arkansas privatize Medicaid expansion; idea could spread like wildfire, as in Florida, but cost questions remain.Princessiccia

Affordable Care Act health care costs health care reform health insurance health policy insurance Medicaid Patient Protection and Affordable Care Act politics state governments

Gusty 18:58 Add Comment

Arkansas has turned heads nationally with its preliminary plan to expand Medicaid using the private insurance market, showing that the Obama administration is willing to give states more flexibility than expected in expanding the program.

Health and Human Services Secretary Kathleen Sebelius has agreed to a proposal by Arkansas Gov. Mike Beebe to reject the Medicaid expansion but use federal money to buy private health insurance for the 200,000 people who would have been covered under ordinary expansion, reports Sandhya Somashekhar of The Washington Post.

States that have come down on either sides of the Medicaid-expansion issue may reconsider their decision in light of the Arkansas proposal, said Sara Rosenbaum, a health law professor at George Washington University. "If Arkansas is allowed to do this, I expect it to spread like wildfire," Rosenbaum told the Post.

The first place could be Florida, where a state Senate committee rejected Republican Gov. Rick Scott's expansion plan and proposed a privatization plan like that in Arkansas. Last week, a House committee voted to reject any expansion of the program. Scott "made it clear he was not going to lobby the Legislature on Medicaid," preferring to emphasize other issues, The New York Times' Lizette Alvarez reports. For coverage from the Tampa Bay Times and The Miami Herald, click here.

Could the wildfire spread all the way up to Kentucky?

Gov. Steve Beshear has said he wants to expand Medicaid in Kentucky if the state can afford it, but many Republican lawmakers oppose the idea, saying it would not be fiscally responsible. On the national level, 26 states and the District of Columbia have expressed a desire to expand Medicaid, 17 have said they reject it and seven are undecided, according to the nonpartisan Kaiser Family Foundation.

A more flexibile arrangement could be a game changer because it makes expansion more appealing, especially for states where expanding Medicaid has been politically unpopular and polarizing. in Arkansas, which has a Democratic governor and a Republicna legislature, officials say that from an ideological standpoint, using private insurance appeals to lawmakers from both parties, reports Somashekhar. She reports that even Democratic-led states might prefer this arrangement because it gets rid of some bureaucratic hurdles.

However, there are questions about cost. The Congressional Budget Office estimates that private insurance plans cost $3,000 more per person than Medicaid, reports Somashekhar. On the other hand, Arkansas officials say the move could ultimately save money in administrative charges along with other cost-control measures.

Although the Arkansas proposal is not concrete, it provides proof that the Department for Health and Human Services encourages innovative, state-based approaches to promote expansion. Many states may develop a new route best suited to their specific needs, without having to leave federal money on the table. (Read more)

Princess Health and Bill to make Medicaid managed-care firms pay up, and more promptly, nears final form in House and will get attention in Senate.Princessiccia

Princess Health and Bill to make Medicaid managed-care firms pay up, and more promptly, nears final form in House and will get attention in Senate.Princessiccia

health policy legislation legislature managed care Medicaid state government; General Assembly

Gusty 06:44 Add Comment

By Molly Burchett and Al Cross
Kentucky Health News

The complaints by many health-care providers about Medicare managed-care firms' delay or denial of payment claims appears to be generating a bipartisan solution in the General Assembly. A bill on the House floor that would transfer late-payment complaints to the state Department of Insurance, which enforces Kentucky's prompt-payment laws, appears to have support in the Senate.

House Bill 5 would apply the prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

Hospitals, doctors and other health care providers have complained that the cabinet is not resolving their payment disputes with managed-care firms. The bill cleared the House Health and Welfare Committee Feb. 21 and is awaiting a vote on the House floor. The bill is sponsored by House Speaker Greg Stumbo.

Sen. Julie Denton, chair of the Senate Health and Welfare Committee, told Kenny Colston of Kentucky Public Radio that she plans to give the bill a hearing and supports its intent to make managed care organizations pay providers. "I think anything we can do to have more oversight and more assistance in keeping them in compliance with their contracts is a welcome breath of fresh air," she said.

Senate President Robert Stivers said he has concerns about the bill affecting the MCOs contracts with the state. But he said his chamber will take a look at the bill, Colston reports. The cabinet has had the same concerns, and some other objections that are to be addressed by House floor amendments.

Kentucky providers report being burdened by a lack of or delayed payments from the new managed-care system. Kentuckians have called for immediate action by state government to help fix these issues on behalf of providers and patients, which has prompted this bipartisan legislative response.

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.

Princess Health and Foundation for a Healthy Kentucky gives UK $1 million for endowed co-chairs in rural health policy.Princessiccia

Princess Health and Foundation for a Healthy Kentucky gives UK $1 million for endowed co-chairs in rural health policy.Princessiccia

Foundation for a Healthy Kentucky health policy public health rural health University of Kentucky

Gusty 06:16 Add Comment

Tyrone "Ty" Borders in the University of Kentucky College of Public Health's Department of Health Services Management, and Brady Reynolds in the UK College of Medicine's Department of Behavioral Science, have been named the Foundation for a Healthy Kentucky endowed co-chairs in rural health policy.

A $1 million gift from the foundation to the College of Medicine was matched by the state Research Challenge Trust Fund, better known as "Bucks for Brains." The gift has the goal of enriching Kentucky's research capabilities in regards to rural health issues and rural health policy.

Reynolds earned doctoral and master's degrees in life-span developmental psychology from West Virginia University. He also holds a master's degree in general/experimental psychology and a bachelor's degree (magna cum laude and with distinction) from James Madison University. His research has focused on nicotine use by adolescents, drug use, gambling and other addictive behaviors. In recent years Reynolds has begun research to promote smoking cessation among pregnant smokers in rural Appalachia.

Borders earned doctoral and master's degrees in health administration, as well as a master's degree in epidemiology from the University of Iowa, and a bachelor's degree in psychology from the University of Kansas. His research focuses on the conduct and analysis of population-based studies to identify subgroups of persons at risk for poor health and problems obtaining health services, with an emphasis on rural populations.

�Drs. Reynolds and Borders have skills in intervention research and rural health policy expertise that can help the University remain at the forefront of rural health policy work in today�s rapidly changing healthcare environment,� said Susan Zepeda, president and CEO of the foundation.

The mission of the foundation is to addresses the unmet health care needs of Kentuckians. Mission objectives are advanced through two initiative areas: promoting responsive health policy and a new children�s initiative named �Investing in Kentucky�s Future.� Foundation work aims to improve access to health care, reduce risks and disparities, promote health equity and healthy lifestyles. Since 2001, over $22 million has been invested in health policy research and demonstration grant projects across Kentucky

Princess Health and Three Kentucky health departments in first group up for national accreditation; requires local health assessment, improvement plan.Princessiccia

Princess Health and Three Kentucky health departments in first group up for national accreditation; requires local health assessment, improvement plan.Princessiccia

Cabinet for Health and Family Services county health boards county health departments health departments health policy public health

Gusty 14:41 Add Comment

By Molly Burchett
Kentucky Health News

Three Kentucky health departments are among the first in the nation to be considered for national accreditation, a process that could help improve patient care and put the agencies in closer touch with their communities' needs.

The national Public Health Accreditation Board will make its first accreditation decisions next week. Among the first group being considered are the Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties.

The decision will be a historic one, and this is an exciting time for the board and Kentucky, said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health.

The accreditation program was launched in September 2011 after a seven-year development process aimed at advancing quality and performance and value in the departments, and their accountability to stakeholders, Scutchfield said.

Departments are assessed by rigorous standards tested in 30 diverse health departments across the country to ensure essential public health services are provided in the community, according to the board's website. Two of the 12 "domains" of the standards deal with administration and governance. In Kentucky, state law makes county health boards responsible for the health of the county. Counties served by district health departments still have county boards.

Accreditation can help a board and department identify opportunities to improve performance and management, and to improve relationships with the community, since the process requires a community health assessment, a community improvement plan and a strategic plan to address the need of the community, said Scutchfield.

The process, often called "Mobilizing for Action through Planning and Partnerships," can help boards and departments be better prepared to proactively respond to emerging and re-emerging health challenges. For a PDF of Franklin County's MAPP document, click here.

The accrediting board has received 108 applications from health departments around the nation: 13 state health departments, 94 local health departments and one tribal agency. In addition to the three Kentucky agencies being considered in the first group, the other Kentucky departments that have applied for accreditation and are awaiting site visits are Lexington-Fayette County, Barren River District, Madison County and Christian County, Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services, said in an email.

The accreditation process encourages departments to move away from the "silo" model to collaborate with community programs. In Christian County, it has changed the way department employees view their jobs, because they have to continuously reflect on their methods and brainstorm for ways to improve, Health Department Director Mark Pyle told Nick Tabor of the Kentucky New Era.

"Accreditation will likely open new revenue streams," Tabor writes. "But in a way, the process matters more than the status designation."

Midkiff said, "In addition to benefiting from the process itself, our federal and state resources in public health are increasingly shrinking, we are being asked to do more with less. And there is a need for transparency within agencies."

Midkiff said accreditation "may make the agency more competitive for grants in the future. We are actually seeing quality improvement and performance management requirements being written in many federal grants now, so it is being expected at the national level."

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year.

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

Princess Health and Bill to shield nursing homes from lawsuits clears Senate along party lines; not looking healthy in House despite TV, radio ads.Princessiccia

Princess Health and Bill to shield nursing homes from lawsuits clears Senate along party lines; not looking healthy in House despite TV, radio ads.Princessiccia

advertising health journalism health policy legislation legislature lobbying long-term care newspapers nursing homes politics state government; General Assembly tort reform

Gusty 13:52 Add Comment

Last week the state Senate approved on party lines a bill that would make lawsuits against nursing homes go through a review panel first. Republicans supported the bill and Democrats voted against it in a 23-12 vote that marked the clearest partisan split in the Senate in this year's legislative session.

Senate Bill 9 would create medical review panels of three physicians and an attorney moderator to hear complaints against long-term care facilities and vote on whether the suit had enough merit to go to court.  The bill's sponsor, Senate Health and Welfare Chairwoman Julie Denton, R-Louisville, declind to answer an opposign senator's questions about the bill. She said in introducing it that the panel would be advisory but its opinion would be admissible in court and would curb such lawsuits, reports Jack Brammer of the Lexington Herald-Leader.

Bills like this have failed in years past and could have diverse implications for Kentucky communities and nursing homes. At least one Kentucky newspaper looked around and found that lawsuits are one reason Extendicare Health Services Inc. shed management responsibilities last year for all 21 of its facilities in Kentucky, reports Nick Tabor of the Kentucky New Era in Hopkinsville.

Without Extendicare management in Western Kentucky, the volume of nursing-home lawsuits in the region appears to be shrinking, Tabor reports. In recent years, nearly all the Christian County cases that have been closed were dismissed through settlements, not by judges declaring them unfounded. This suggests the bill would minimally affect the county, writes Tabor. Other Kentucky communities may be affected differently; judges differ from circuit to circuit.

Although the bill passed the Senate, it appears to be on its deathbed in the House. Rep. Tom Burch, D-Louisville, who chairs the House Health and Welfare Committee, joked about its prospects to Tabor: �I can�t make any predictions about the bill this time, but I�ve called in three priests to have the last rites ready.� If nursing homes received this new layer of protection, he said, hospitals and day-care centers would want it too.

A similar bill died in Burch's committee last year; this version is being supported by television and radio commercials urging viewers and listeners to call their legislators in support. When Extendicare announced last spring it was transferring management of all its Kentucky facilities to a Texas company, it cited Kentucky�s �worsening litigation environment� and said tort reform seemed unlikely here.

Bernie Vonderheide, director of Kentuckians for Nursing Home Reform, said most so-called �frivolous� lawsuits would cease if the state imposed minimum staffing requirements on nursing homes, his group's main legislative goal. (Read more)

Princess Health and Medically unnecessary procedures are part of culture of disability in Eastern Kentucky, professor writes.Princessiccia

Princess Health and Medically unnecessary procedures are part of culture of disability in Eastern Kentucky, professor writes.Princessiccia

disabilities health policy heart disease hospitals rural health

Gusty 06:05 Add Comment

St. Joseph London Hospital is taking heat over accusations of performing medically unnecessary cardiac catheterizations and other invasive cardiac procedures, and a look at the health data by a Kentucky physician suggests that the phenomenon is broader and reflects cultural problem in Eastern Kentucky.

An examination of health data by Dr. Peter Hasselbacher, a retired internist and professor emeritus at the University of Louisville, confirmed that St. Joseph London performed a large number of invasive heart procedures for such a relatively small, rural hospital.  Many patients have sued the hospital, alleging unnecessary procedures, notes a story in The Courier-Journal.  And when the hospital came under federal supervision, the frequency of its most commonly performed stent-angioplasty procedure dropped by 37 percent, Hasselbacher reports on his Kentucky Health Policy Institute blog.

As the number of St. Joseph London procedures dropped sharply, there was a more dramatic increase in catheterizations and angioplasties statewide. From 2010 to 2011, the number of the most commonly reported angioplasties in Kentucky increased from 12,803 to 22,688, a 77 percent increase, reports Hasselbracher.

This map showing how many people living in each of Kentucky�s counties underwent a percutaneous transluminal coronary angioplasty (PTCA) in 2010. This is the most common invasive cardiac procedure in Kentucky and is used to prevent and treat heart attacks.

In this map, the darker the shade of blue, the greater percentage of people living in that county had an angioplasty in 2010. The differences among the counties is staggering. It ranges from a low of 42 people per 100,000 in a single year, all the way up to 1,700 per 100,000 � a 40-fold difference. In the counties with the highest rates, between 1 percent  and 2 percent of the county's population underwent the procedure in a single year.

These rates are based on where people live, rather than where they go to the hospital, and the counties with the highest rates are in Appalachia. Hasselbacher calls Eastern Kentucky is "an angioplasty factory" and says the phenomenon can't be be fully explained by the simple fact that people in the region are sicker than those in the rest of the state; he offers another explanation.

"It is my belief that a major, perhaps even the major segment of the economy of Eastern Kentucky revolves around the getting of disability and the keeping of disability" and its government benefits, Hasselbacher writes. "As other industries such as coal and tobacco have faded in importance, the pursuit of disability, medically justified and not, has drained away resources from medical services into an ersatz unemployment and social support program."

Hasselbacher, left, says he doesn't wish to imply that the people of Eastern Kentucky are morally distinguishable from the rest of us, or that their health-care professionals are any less professional. He acknowledges that the region has had an uphill struggle for many years, and it is easy for providers to fall into the trap of wanting to do everything and anything to help patients.

"A culture has evolved in which being sick or just having a diagnosis of being sick is a gateway to economic security for people and professionals alike," Hasselbacher writes. "Some patients, doctors, hospitals, and lawyers wittingly or unwittingly support that process. Doing medially unnecessary diagnostic testing and treatment is part of that culture. It is also good for business." (Read more)   

Princess Health and 'Health for a Change' webinar training series starts May 16, with session on where to find and how to use health data.Princessiccia

Princess Health and 'Health for a Change' webinar training series starts May 16, with session on where to find and how to use health data.Princessiccia

health policy

Gusty 04:28 Add Comment

How to find county-specific health data and how to use it to make community changes will be the focus of an hour-long webinar May 16.

The free session is the first in the 2012 "Health for a Change" training series, meant to advance today's health issues in Kentucky. It is sponsored by the Foundation for a Healthy Kentucky. "We have procured excellent speakers to present best practices and proven models of these skills in a combination of electronic webinar format and in-person workshops," a foundation press release says.

The June 20 workshop will provide training on building and maintaining a local health coalition. Other webinars this summer will help identify differences between advocacy and lobbying, discuss evidence-based policies and programs, give instruction on budgeting and teach how apply for grant funding.

The May 16 webinar will be held from 3 to 4 p.m. To register for it or the entire "Health for a Change" series, click here.

Princess Health and New oral health coalition expected to spur changes in state.Princessiccia

Princess Health and New oral health coalition expected to spur changes in state.Princessiccia

dentistry dentists health policy oral health state law tooth decay

Gusty 06:10 Add Comment

By Tara Kaprowy
Kentucky Health News

For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he's seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.

Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that "teeth are just something to get rid of," Howard concedes that making headway can feel like one step forward and two steps back.

Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.

Dozens of organizers and stakeholders met in March to discuss the coalition's aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships statewide and advocate oral-health legislation. "I think they will turn into the advocacy group for dental change," said Dr. Julie McKee, dental director for the state Department of Public Health. "They're working hard to come up with a plan. They've got their heads on straight."

One of the major issues facing the dental profession is possible expansion of the scope of practice for mid-level providers, such as dental therapists who can assess, clean teeth, replace sealants, provide fluoride as well as fill cavities and extract teeth. As nurse practitioners do in the medical field, having such providers could help address shortages in rural areas, said Dr. Jim Cecil, former state dental director and coalition steering committee chair. The concept is in practice in 54 other countries, but the only U.S. states with it are Minnesota and Alaska, mainly because of opposition form dentists.

Andrea Plummer, coalition member and senior policy analyst for Kentucky Youth Advocates, acknowledged that scope-of-practice issues "can be a very tense subject" and "there would have to be buy-in" from members of the committee, who include dentists, but discussion is ongoing. Cecil said the issue is "something we'll need to look at and take a stand on eventually."

Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn't feel Kentucky's oral-health problems can be solved just by putting more boots on the ground.

"The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don't change the mindset, if we don't provide the education, I don't think we're going to solve the problem," he said.

To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.

A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. "Kentucky law says that students' health does affect their learning and schools should take steps to affect their learning but it's fairly broad," she said.

An analysis by KYA last year showed school districts spend less than 1 percent of their budgets on school health services.

Examining how to get more dentists to accept Medicaid patients is another hot-button issue. Of about 2,200 dentists statewide, only about 600 are enrolled in Medicaid, Cecil said, and "They feel like they're working for free" because of the program's low reimbursements. "In many cases, they're really not meeting overhead."

The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. "Everything they do has to be pre-authorized," he said. "That delays approval, delays treatment, delays payment."

Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. "The more times they have to come, that gives them more opportunities to miss appointments," Howard said.

The Oral Health Coalition also sees a need for "quality, updated data," Plummer said. Getting data was one of the successes of the first coalition, formed in 1990. Run by volunteers and funded by the dental schools at the University of Kentucky and University of Louisville, it was formed after the General Assembly told the schools that they either needed to work together or one could "risk being shut down," Plummer said. The group had several successes, including working with the state to conduct an oral health survey, lobbying legislators for oral-health measures and holding an annual symposium. But after more than 15 years, "It kind of just fizzled out a little bit," Plummer said. The group went inactive in 2006 but had some assets that the new group will take over.

The group's rebirth began in 2009, when Kentucky Youth Advocates was approached by the DentaQuest Foundation, which is connected to DentaQuest, one of the largest managed-care organizations in the country that administers dental benefits. DentaQuest officials were interested in seeing the coalition resurrected and offered $80,000 to KYA so it could provide the manpower to run it, Plummer said. It was the first time the coalition had funding to back it up. The KYA talked to state stakeholders and discovered "there really did seem to be an interest in putting a coalition back together," Plummer said. Planning began in earnest and in January the steering committee drafted by-laws. In March, 70 people showed up to the first meeting.

That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. "When we have people from all these different venues, we have more of an opportunity to make a difference," he said.

The coalition's next meeting will be July 25. Those interested in attending or becoming members of the coalition can contact Andrea Plummer at aplummer@kyyouth.org or 502-895-8167. Dues for individual members are $25. Government organizations pay $100, nonprofit organizations pay $250 and for-profit organizations pay $500.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.