Princess Health and Conflicting interpretations abound regarding CBO's report about cost, coverage of Affordable Care Act.Princessiccia

Princess Health and Conflicting interpretations abound regarding CBO's report about cost, coverage of Affordable Care Act.Princessiccia

Affordable Care Act health reform Patient Protection and Affordable Care Act

Gusty 17:03 Add Comment

By Tara Kaprowy
Kentucky Health News

Since the Congressional Budget Office released a report with revised estimates about how many people the Affordable Care Act will cover and how much it will cost, it has spawned a whirlwind of op-ed pieces with vastly opposing interpretations.

According to Julian Pecquet in The Hill, the estimate showed the federal health-care reform law will allow 30 million more people to get insurance coverage by 2016, down from the previous estimate of 32 million. Thus, the law's coverage provisions are now estimated to cost $1.083 trillion over the next 10 years, $50 billion less than last year's projection.

The CBO also estimates that 4 million Americans will lose their employer-sponsored health insurance by 2016, not the mere 1 million figure projected last year. It also estimates that 1 to 2 million fewer people will qualify for state health-insurance exchanges than initially thought, but an additional 1 million will qualify for Medicaid or the Children's Health Insurance Provision, known in Kentucky as K-CHIP.

"CBO faults a slower than anticipated recovery for the soft numbers, along with technical changes to CBO's estimating procedures and legislative changes adopted over the past year," Pecquet reports. The changes in cost estimates are "due in part to slower growth in health-care spending resulting in an 8 percent drop in premiums, as well as taxes and penalties paid by employers and their workers as struggling businesses cut down on employer-sponsored coverage," Pecquet writes.

Conn Carroll, senior editorial writer for The Washington Examiner, has an entirely different view, saying the cost has doubled. "The gross cost of President Obama's health care law has risen from $940 billion when the bill was passed, to $1.76 trillion today. This did not sit well with Obamacare's leftist apologists," he writes. Carroll uses gross figures to arrive at his calculations.

Carroll is comparing apples to oranges, and the estimate hasn't doubled, writes Ezra Klein of The Washington Post. "The disparity in the cost estimates only comes when you take a different sample of years, in which the law is doing different things, in an economy of a different size. And even then, costs went up only if you take "gross" costs rather than "net" costs, which is a rather unusual way to think about the budget."

Paul Krugman of The New York Times weighs in too, but not on the numbers. He does say, "For all its imperfections, this reform would do an enormous amount of good. And one indicator of just how good it is comes from the apparent inability of its opponents to make an honest case against it."

Krugman said "most of the disinformation" about the reform is about costs. "Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when � as was the case with the latest report � the document says on its very first page that projected costs have actually fallen slightly."

CBO Director Douglas Elmendorf defended in his blog the changes in estimates. "We will continue to update our estimates regarding health insurance coverage as new information becomes available about the implementation of the ACA, underlying trends in the health-care and health financial systems, and the probable responses to the legislation by businesses, families and others."

Princess Health and Affordable Care Act helping families, seniors in rural areas, agriculture secretary says on its second anniversary.Princessiccia

Princess Health and Affordable Care Act helping families, seniors in rural areas, agriculture secretary says on its second anniversary.Princessiccia

Affordable Care Act Patient Protection and Affordable Care Act rural health rural medicine

Gusty 17:00 Add Comment

The Patient Protection and Affordable Care Act is already making an impact, including for people who live in rural America. That was the message from Agriculture Secretary Tom Vilsack today on the second anniversary of the enactment of the federal health-care reform law.

In a teleconference, Vilsack noted several pieces of the law that are benefitting people, including the 2.5 million young adults who have insurance coverage because parents can keep them on their plan up to age 26. "That's providing a degree of comfort to moms and dads," he said.

The law has also helped 3.6 million seniors on Medicare, who saved $2.1 billion on their prescription drugs in 2011 because the law allowed them to get a 50 percent discount on brand-name drugs. Vilsack said seniors saved an average of $600 last year and were also "able to get a number of services, including preventive services like mammograms, for free."

Under the law, insurance companies are now required to spend 80 percent of their premium dollars on "actual health care, not overhead," Vilsack said, and they are not allowed to increase their premiums by more than 10 percent without an explanation. Children who were previously denied coverage because of pre-existing conditions can no longer denied, as per the law's mandate, and "in a couple of years that will extend to all people," Vilsack said. And thousands of new primary-care doctors and nurses are being encouraged to practice in rural areas and will receive higher payments.

Vilsack said his Department of Agriculture is working to improve the rural health-care landscape, through a joint effort with the USDA Rural Development division and the Department for Health and Human Services. In the past three years, Vilsack said 730 counties have received grants so they can "embrace telemedicine." Nearly 600 health-care facilities in rural communities have received money to fund equipment like CT scans, MRIs, ultrasound and lab equipment, Vilsack said. And rural citizens can now get care from a hospital outside their health plan's network when there is no time to get to a hospital that is farther away.

"No one should have to go without health care because of where they live, and for too long, rural Americans have been getting the short end of the health-care stick," he said. "The Affordable Care Act is helping millions of young people access health care, strengthening Medicare, and training thousands of new doctors to serve rural areas to give middle-class families the health security they deserve." (Read more)

Princess Health and Reform act good for kids, Kentucky Youth Advocates head says.Princessiccia

Princess Health and Reform act good for kids, Kentucky Youth Advocates head says.Princessiccia

Affordable Care Act children's health health reform Patient Protection and Affordable Care Act

Gusty 16:51 Add Comment

This week marks the second anniversary of the Affordable Care Act and debate about its cost and benefits continues to be vigorous. But one thing that can't be denied "is that the ACA, on a most basic level, benefits vulnerable kids in Kentucky," writes Terry Brooks, right, executive director of Kentucky Youth Advocates, in an op-ed piece in the Lexington Herald-Leader.

"Today, because of the ACA, kids with pre-existing conditions like diabetes and asthma can't be denied the care they need," he writes. "And children across Kentucky are receiving preventive care like immunizations without their parents having to pay out-of-pocket costs so they can avoid illness and we can avoid unnecessary health care costs for preventable problems."

Brooks also notes that the ACA allows children to be covered under parents' insurance up to age 26.

If provisions of the ACA are not revoked, children can continue to benefit into their adulthood, Brooks writes: "They'll be protected from their insurance companies placing lifetime caps on their coverage and benefits, so if a child beats leukemia at age eight, she will still be able to get the care she needs if she relapses at age 20." That will translates to 360,000 children in Kentucky being protected. "And more than 180,000 Kentucky children will be able to receive preventative care such as well-child visits and other screenings with no out-of-pocket costs," he writes.

"So, yes, let's debate the pros and cons," he said. "But let's not deny the simple fact that the ACA is good for kids, and kids should be spared from the politics and animosity of this debate." (Read more)

Princess Health and Knox County Hospital bounces employees' checks; blames old, bad debt and late Medicaid payments.Princessiccia

Princess Health and Knox County Hospital bounces employees' checks; blames old, bad debt and late Medicaid payments.Princessiccia

hospitals managed care Medicaid

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Debt inherited from previous management and late Medicaid payments caused some Knox County Hospital checks to bounce. Most of the facility's employees could not cash their checks last Friday afternoon.

"It was more of an accounting issue than anything and had we known that this was going to happen, we would have put personal money into it and this wouldn't have happened," said Dr. Satya Chatterjee, a management owner. Hospital CEO Craig Morgan said, "That money is starting to come; it's just not coming fast enough, so hopefully we're past the worst of it." Morgan said he "takes the blame for the billing issue and actually had all people in administration hold their checks so other employees were paid as soon as possible,"  Jerrika Insco reports for WYMT-TV.

It is not the first time the hospital has bounced checks, . "Ever since Medicaid was implemented, the CEO says the hospital has struggled financially," Insco reports.

Presumably, she means managed care for Medicaid, which has prompted many complaints from health-care providers. Since the legislative session began, lawmakers have heard gripes about the state's three new managed-care companies, who took over Kentucky's Medicaid program outside the Louisville region Nov. 1. The companies have been too slow to reimburse providers and require burdensome pre-authorizations before treatment can be provided, critics say. State Auditor Adam Edelen said the companies are sitting on "north of a quarter billion dollars of taxpayer dollars. That's something that requires an explanation to the people of Kentucky." (Read more)

Princess Health and Legislation to fight pill mills will need to strike balance between law enforcement and medicine, panelists on TV show make clear.Princessiccia

Princess Health and Legislation to fight pill mills will need to strike balance between law enforcement and medicine, panelists on TV show make clear.Princessiccia

pain clinics pill mills prescription drug abuse state government; General Assembly

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By Tara Kaprowy
Kentucky Health News

The legislation meant to crack down on so-called "pill mills" will turn on striking a balance between thwarting prescription drug abuse and making sure doctors and patients don't feel their hands are tied, it became clear on statewide television Monday night.

On KET's "Kentucky Tonight," Attorney General Jack Conway argued strongly for the legislation, as did state Rep. John Tilley, D-Hopkinsville, chair of the House Judiciary Committee. Dr. Shawn Jones, president of the Kentucky Medical Association, said physicians are interested in fixing the problem but don't want legislation to be overly burdensome. State Sen. Tom Jensen, R-London, chair of the Senate Judiciary Committee, would not commit to either side, but did voice some concerns.

Conway said 90 Kentuckians a month die from prescription-pill overdoses, and Kentucky is the fourth most medicated state in the country. And he said the problem is expected to grow, with 80 percent of middle-schoolers saying they know someone who has used prescription pills for off-label purposes.

But Jones warned legislators should not over-reach. "When we write legislation and we try to mandate medical care, it's very difficult," he said. "We think primarily our role as physicians is to protect the right of the patient to relieve suffering. . . . We think we need to address this problem. How to do that is the big issue."

Right now, all prescriptions dispensed in Kentucky are tracked through the Kentucky All Schedule Prescription Electronic Reporting, a system known as KASPER. The Cabinet for Health and Family Services is charged with tracking disturbing trends that show up in the system and conveying those anomalies to the doctor-dominated board that licenses doctors. That is not happening, Conway said. "In my first four years in office, I've never gotten a referral from the Kentucky Board of Medical Licensure," he said, adding under the current system law enforcement has no way to "get at the data" unless they already have a case file opened.

House Bill 4 would put Conway's office in charge of tracking KASPER data and allow it to track data without opening a case. It would also require pain clinics to be owned by doctors or advanced registered nurse practitioners and require doctors to use KASPER when seeing new patients and periodically thereafter. Now, only about one in four physicians have KASPER accounts, Conway said. An alternative measure, Senate Bill 98, would not shift power to Conway's office, but would require that doctors be the owners of pain clinics.

Jones said requiring doctors to use KASPER is too heavy-handed, in part because the system does not instantly respond to doctors' requests. Conway acknowledged the system is old and "needs to be updated," but said Gov. Steve Beshear set aside $4.5 million in his proposed budget to do so.

Patient privacy is another consideration, since House Bill 4 would also allow county and commonwealth's attorneys, along with law enforcement, access to KASPER data, Jones said. Jensen pointed out another concern: "You don't want to have a chilling effect on physicians to prescribing medications on a patient. I hate to think we're doing something where doctors are going to say, 'I don't want to give someone pain meds because I might be monitored and I might get in trouble.'"

Bob Talley of Bowling Green, who called in to the show and said he has chronic pain, agreed with Jensen, saying he "certainly does not want the political process to make it harder for my doctor and harder for me to get legitimate treatment."

Though Jensen pointed out potential problems, he said he is "still in the mode where I'm learning" because he hasn't been involved in the process of sculpting what has been proposed. "I think this is a broad bill, it's a big bill that we need to look at cautiously," he said.

Tilley agreed "the devil is in the details," but said something needs to be passed before the impending end of the legislative session. "This is a scourge. People are dying," he said. "It's imperative we act this session."

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.

Princess Health and House panel OKs "meds for meth" bill; chair predicts passage.Princessiccia

Princess Health and House panel OKs "meds for meth" bill; chair predicts passage.Princessiccia

drugs General Assembly legislation legislature lobbying meth methamphetamine

Gusty 17:29 Add Comment

The bill to limit purchases of the cold medicine used to make methamphetamine cleared another legislative hurdle Monday, and the chairman of the committee that approved it predicted that it will become law despite a heavy lobbying effort by over-the-counter drug makers.

By a 10-4 vote, the House Judiciary Committee approved a version of Senate Bill 3 that differs slightly from the version passed by the Senate. Rep. John Tilley, a Hopkinsville Democrat and the committee�s chairman, predicted the revised SB 3 will pass on the House floor. "Tilley said Senate leaders have signed off on the changes the House committee made," Jack Brammer reports for the Lexington Herald-Leader. The House version clarifies "language regarding prescriptions" and would ban "criminals convicted of meth-related offenses from purchasing pseudoephedrine for a five-year period," Mike Wynn of The Courier-Journal reports.

The core of the bill would allow consumers without meth records to buy 7.2 grams of medicines with pseudoephedrine each month, approximately a two-week dose, and up to 24 grams per year, without a prescription. Another 7.5 grams a month or 90 grams a year could be available with a prescription. "Experts have testified that those amounts are adequate for most cold and allergy sufferers, and more than 90 percent of all purchasers use dosages that fall below the proposed thresholds," Wynn reports. "State law already limits purchases to 9 grams per month, with a yearly cap of 108 grams, and purchasers are required to present a photo ID and sign a log at the point of sale."

The bill would not apply to gelcaps, which are more difficult to use for meth, or liquids, which are used for children. (Read more)

Princess Health and Amid legislative action on 'Larry's Law,' report says mentally ill and intellectually disabled don't belong in personal-care homes.Princessiccia

Princess Health and Amid legislative action on 'Larry's Law,' report says mentally ill and intellectually disabled don't belong in personal-care homes.Princessiccia

General Assembly legislation mental health mental illness

Gusty 16:58 Add Comment

By Tara Kaprowy
Kentucky Health News

As state legislators move to change the procedure for admitting mentally ill patients to personal-care homes, a new report argues those patients shouldn't be in the institutions at all � and neither should people who have intellectual disabilities.

Kentucky Protection & Advocacy, an independent state agency, argues personal-care homes promote "congregate" and "segregated" living arrangements and, as such, run counter to the Americans with Disabilities Act and a court decision saying disabled patients  should live in the "most integrated setting," meaning one "that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible."

The report is based on data collected from 218 people in 20 of Kentucky's more than 80 free-standing personal-care homes. Of the facilities visited, 85 percent of the residents living there either had a mental-health diagnosis or an intellectual disability. The visits were unannounced, and individuals were asked at random if they wanted to participate in the survey.

The report found residents in personal-care homes are often restricted from their community either because of lack of transportation � nearly 43 percent said they had to walk in order to go anywhere � or because the home is geographically isolated from most of the community. Staff also rarely plan outings, with one in three respondents saying it never occurs. Another 14 percent said it happens "a couple times a year" and 14 percent said it happens weekly.

Though community mental health centers have programs for counseling and rehabilitation, only 13 percent of personal-care home residents said they go. "Many residents expressed interest in attending the therapeutic rehabilitative programs and the community mental health center for counseling or case management services; however, the staff at PCH would not arrange it," the report reads.

Adding to the argument that residents live in a congregate arrangement, the report points out residents are "subjected to regimented meal times, often with assigned seating, medication, smoke breaks, curfews and bedtimes;" have roommates but are not able to choose them; are not always allowed to refuse to take their medication; and have limited visiting hours.

Still, when asked if they have any complaints about living in a personal-care home, 51.2 percent said they didn't. Nearly 46 percent said they did, and 3.2 said they were unsure. Being lonely or having nothing to do was the single biggest complaint. To download the report in PDF form, click here.

Two bills have been filed to change the way people with mental illness or intellectual disability would be admitted to personal-care homes. Senate Bill 115, which the Senate Health and Welfare Committee approved today, would require that a potential resident receive a medical exam that includes a medical history, physical exam and diagnosis before being admitted. The same would be required by House Bill 307, which would also require more assessment for a person with an acquired brain injury. It hasn't seen action since it was posted in committee Feb. 6. 

The bills are dubbed "Larry's Law," after Larry Lee, who disappeared in August from Falmouth Nursing Home. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four weeks after his disappearance on the banks of the Licking River, which flows through Falmouth. (Read more)

"Larry Lee is not the first person to walk away from a personal care home and die," Beth Musgrave and Valarie Honeycutt Spears write for the Lexington Herald-Leader, citing cases from Grant and Letcher counties. (Read more)