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Friday, 11 March 2016

Princess Health and This year's smoking-ban bill is dead; Senate advocates have bill to make insurers provide all smoking cessation treatments. Princessiccia

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By Melissa Patrick
Kentucky Health News

Despite early hope, the bill to ban smoking in Kentucky workplaces was likely dead on arrival this year.

"I haven't heard anything about the smoking ban bill in . . . well, really since the start of the session," House Speaker Greg Stumbo, D-Prestonsburg, said in an interview. "So, I would say yes, it's dead."

Rep. Susan Westrom
"The timing has just not been right," said Susan Westrom, D-Lexington, sponsor of the bill. "We don't have the votes. It seems like in every election year, people are afraid to vote on something like this that they perceive to be controversial."

In addition to it being an election year, Westrom elaborated on a long list of other reasons for why the smoking-ban bill hasn't had any support this year, including: it being a budget year, a new Republican governor and Senate leadership that don't support it, less organization from advocates, a quiet public and the loss of several funding streams.

"There's always next year," Westrom said. "This isn't an issue that will go away because we can't ignore that Kentucky is one of the least healthy states in the country. It always has to be at the top of our priority list."

The latest Kentucky Health Issues Poll found that two-thirds of Kentucky adults support a comprehensive statewide smoking ban, and have since 2013. The ban has support from solid majorities in each political party and has majority support in every region of the state. But more than one-fourth of Kentucky adults are smokers.

Last year was the first year Westrom's smoking ban bill passed out of the House with a vote of 51-46. The bill was then placed in an unfavorable Senate committee and never brought up for discussion. This is the sixth year she has sponsored this bill.

"I have enjoyed carrying this bill more than anything I've done over the years because it is the right thing to do and because I really, really care about the health of Kentucky," she said wistfully.

Republican Sen. Ralph Alvarado, a Winchester physician, said in an interview that he had worked very hard this session to get a smoke-free bill together in the Senate, but he just couldn't get the votes.

Instead, Republican senators Julie Raque Adams from Louisville and Alvarado have filed Senate Bill 291 that would require insurers in Kentucky to cover all approved smoking cessation treatments, counseling and medication. Currently, many plans only cover some physician-prescribed treatments and/or medications.

A flyer to drum up support for SB291 says the state has nine-thousand smoking related deaths per year; $1.92 billion in smoking related health expenditures; and $590 million in smoking related Medicaid costs. The statewide smoking rate in Kentucky is 26 percent.

"Tobacco is still one of the most expensive cost for our healthcare system in the state," Alvarado said. "Anything that we can do to help get people off of cigarettes voluntarily...I think is going to benefit us financially and is going to save lives."

Adams was pessimistic about the bills chance of passing this year, but said she was hoping for a hearing on it to continue the education process and keep the issue alive.

"The fact that insurance does cover cessation, I think that is a really important thing to get out to the consumer," she said in an interview.

According to Run Switch PR, this bill has the support of the following: American Cancer Society, American Heart Association, American Lung Association, Campaign for Tobacco Free Kids, Kentucky Medical Association, Kentucky Hospital Association, Kentucky Rural Health Association, Kentucky Voices for Health, Kentucky One and Baptist Health. It is currently in the Senate Baking and Insurance committee.

Princess Health and Hard-fought bill to protect independent pharmacies passes Senate committee; would regulate pharmacy benefit managers. Princessiccia

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By Melissa Patrick
Kentucky Health News

Update March 28: SB 117 passed the Senate March 14 with a 38-0 vote and passed the House March 25 with a 97-0 vote. It now awaits the signature of the governor.

Approval of Senate Bill 117 by the Senate Appropriations and Revenue Committee March 11 brought Kentucky's independent pharmacies one step closer to getting better price transparency from the companies that negotiate with pharmaceutical manufacturers, insurance companies and their beneficiaries. The bill would subject pharmacy benefit managers to regulation by the state Department of Insurance.

Republican Sen. Max Wise
"We are talking about independent pharmacies that have had family histories for years," Sen. Max Wise, sponsor of the bill, said in an interview. "They are trying to compete just to stay alive and . . . are suffering right now. This is a fight for the little guy and I am happy to stand up with the independent pharmacies."

Wise, a freshman Republican from Campbellsville, told the committee that while pharmacy benefit managers still don't support his bill, they did come to the table over the last week with independent-pharmacy representatives and the state Cabinet for Health and Family Services to reach a compromise that the committee approved unanimously.

The legislation would allow the Insurance Department to regulate PBMs much like insurance companies are regulated. It would also provide an appeal mechanism to resolve pricing disputes between pharmacies and PBMs.

The bill would not require PBMs to change how they work with fee-for-service Medicaid, nor does it require them to release their pricing methodology unless absolutely necessary, and any releases would not be subject to the state open-records law.

The bill was intensely debated for weeks, first in the Senate Health and Welfare Committee and then heard twice in the A&R Committee. Last week's A&R meeting involved "several hours of testimony from a local pharmacist, PBM representatives, and members of the Cabinet for Health and Family Services," the Kentucky Independent Pharmacist Alliance said in a news release.

Wise, a former FBI agent who was elected in 2014, told the committee, "This has been a very tough and complicated bill to work on."

The legislature passed a "maximum allowable cost" law in 2013 to require increased transparency in reimbursement practices. "Kentucky is one of only a handful of states to regulate the actions of PBMs," said the independent pharmacists' release. It said the state has more than 500 independent pharmacists.

Princess Health and First case of Zika confirmed in Ky., from traveler to Central America; no threat to Kentuckians unless they visit affected areas. Princessiccia

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By Melissa Patrick
Kentucky Health News

After the first case of Zika was confirmed in Kentucky March 9, health officials held a news conference at the Capitol to raise awareness of the virus, noting that the state was coming up on the spring travel season.

Mosquitoes carry Zika. (CNN image)
Gov. Matt Bevin, Health Secretary Vickie Yates Brown Glisson and Dr. Kraig Humbaugh, senior deputy commissioner of the Department for Public Health, emphasized that only those who have traveled to affected areas, like Central and South America, need to worry about contracting the virus, which is commonly transmitted through mosquitoes.

"Many areas, including most of our surrounding states, are reporting Zika cases," Humbaugh said in the news release. "For now, these positive results have only occurred in individuals who have traveled outside the country to places where the virus is currently spreading."

The infected male patient in Kentucky had recently returned to Louisville from Central America. Humbaugh said he presented with signs of fever and rash, which a "very astute" health-care provider suspected as symptoms of Zika.

Common symptoms of the virus are fever, rash, joint pain and red eyes,with symptoms lasting for about a week, according to the U.S. Centers for Disease Control and Prevention. Although many with the virus will not show symptoms, Humbaugh said.

Health officials stressed that Kentucky is not at risk, but said the state has a plan in case the Zika virus spreads. Glisson encouraged health-care providers to be alert to the symptoms of the virus.

She also noted that the Cabinet for Health and Family Services was partnering with Kentucky Emergency Management and the Kentucky Department of Agriculture to increase the monitoring and control of the state's mosquito population this year.

The CDC recommends that pregnant women or those trying to become pregnant postpone travel to affected areas. However, if they must travel to one of these areas, the CDC asks them to talk to their healthcare provider before they leave and strictly follow steps to avoid mosquito bites during the trip.

Humbaugh noted that increasing evidence has found a link between infection in pregnant women and infants born with microcephaly, a condition where the infants head is smaller than normal, which can lead to a variety of other health challenges.

The Washington Post reports that the Zika virus has "growing links to a broad array of birth defects and neurological disorders ... worse than they originally suspected, increasing the risk for devastating harm during pregnancy."

Until Zika, "there has never been a mosquito-borne virus that could cause serious birth deffects on such a large scale," CDC Director Thomas Frieden told reporters.

There is no vaccine or treatment for Zika.  The virus can also be spread through sexual intercourse, and it is still unknown how long the virus stays in semen, Humbaugh said.

Kentucky has at least one mosquito known to transmit Zika.

�We do have Aedes aegypti, but  they are a very small populations, from what I understand from our mosquito experts,� Humbaugh said. �Our entomologists at the University of Kentucky have been advising us on this particular area. However, we have other types of mosquitoes that may be what they call competent vectors. In other words they may be able to spread the disease, but at this point that hasn�t been shown that these other mosquito types are competent vectors.�

Humbaugh encouraged Kentuckians to take normal precautions to limit exposure to mosquitoes like using approved insect repellents, wearing long sleeves and pants when outdoors, to stay inside during dawn and dusk when mosquitoes are most active, minimize standing water and screening windows.

More information about Zika can be obtained from the department's Health Alerts website at http://healthalerts.ky.gov/Pages/Zika.aspx. For a full list of affected countries and regions visit http://www.cdc.gov/zika/geo/index.html.

Thursday, 10 March 2016

Princess Health and March 10th, 2016 I Was Ready. Princessiccia

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March 10th, 2016 I Was Ready

Today required special planning with my food schedule. I was the guest emcee tonight at a college talent show thirty miles away. I had to be there by 6pm with the show scheduled for 7pm. I didn't want to prepare dinner too late, so I opted to keep a good schedule and prepare dinner before leaving for the event.

It's likely the earliest I've finished dinner in more than a year. I made sure breakfast and lunch was on schedule and everything was spaced properly to make it work. And it did work, wonderfully!

I'm not a great planner. I'm okay. I'm a good planner, especially if there's special circumstances like this evening.

My alternative plan, if plan A didn't work, was one I've fallen back on many times--the on-the-go meal; some almonds, cheese and fruit. Plan B is always delicious and super easy. I didn't need it tonight. I was ready.

The organizer of the talent show wanted me to do some stand-up during my emcee duties. I did a short set to lead things off, introduced the judges--then introduced each act. During the transitions between acts, I did a little more stand-up material. Everything went very well. My set was solid and the audience was incredible. I improvised several things based on the material about the judges and some of the individual acts. When you can improvise with an audience and have it work well, that's when you know the conditions are just right. And the huge theatre was beautiful! The talent show contestants were phenomenal. One student made his stand-up comedy debut. That was very cool to watch. And he did well. I really enjoyed encouraging him. 

I enjoyed several spot support communications today. There's amazing things happening within the two support groups I co-facilitate with Gerri Helms. We'll be joined by Kathleen Miles starting with the next ten week sessions. The sessions start 3/21 and 3/22. And we have some spaces available. But not many!

If you're interested, click one of the registration links below. If you have any questions, email me: transformation.road@gmail.com  

Simply click the flyer to enlarge.

To register for Monday nights click here:
http://lifecoachgerri.com/even�/0321-accountability-support/

To register for Tuesday nights click here:
http://lifecoachgerri.com/even�/0322-accountability-support/

Letting the Tweets take it the rest of the way tonight...

My Tweets Today:
































Thank you for reading and your continued support,
Strength,
Sean
Princess Health and McConnell touts bill to fight opioid abuse; blocks extra funding, says money is available and more should require cuts elsewhere. Princessiccia

Princess Health and McConnell touts bill to fight opioid abuse; blocks extra funding, says money is available and more should require cuts elsewhere. Princessiccia

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The U.S. Senate passed a bill 94-1 March 10 aimed at "the growing epidemic of painkiller and heroin abuse," Karoun Demirjian reports for The Washington Post. "Drug abuse has been in the spotlight this political season, with presidential candidates recalling personal stories about relatives and friends who struggled with addiction and lawmakers from states dealing with the crisis highlighting their efforts to address the problem legislatively."

Kentucky Sen. Mitch McConnell, as majority leader, helped lead the effort to pass the bill, along with fellow Republicans who "face tough re-election battles" and whose losses could cost the GOP its majority, Demirjian notes. Sens. Kelly Ayotte (R-N.H.) and Rob Portman (R-Ohio) "supported a Democratic-led, and ultimately unsuccessful, effort last week to add $600 million to the bill to support the treatment and prevention programs it would create." So did Sen. Mark Kirk (R-Ill.), "who is also facing a formidable election challenge."

McConnell opposed the funding amendment, saying there is enough money for the programs already and extra funding must be offset with budget cuts elsewhere. "Senators are now eyeing the appropriations process as the next place they intend to appeal for more drug abuse treatment and prevention funding," Demirjian reports.

McConnell said in a press release, "At a time when more Kentuckians now die from drug overdoses than car crashes, it�s clear that more action is needed."

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, told Beth Warren of The Courier-Journal, �One of the nice things this bill does is sets some standards around treatment.�

"The legislation would establish grant programs to help state and local governments improve education and treatment for drug abuse, encourage medical providers to reduce unnecessary prescriptions, commit resources to help veterans deal with addiction, and give local law enforcement and mental health officials tools to lower the death rate from overdoses," the Post reports. "A key provision would provide states with incentives to make naloxone, which can counteract overdoses, more widely available by offering liability protections to officials who distribute it. The bill�s fate in the House remains unclear."

Princess Health and Bill to keep dirty needles out of landfills hijacked with amendment to require needle-exchange programs to be one-for-one. Princessiccia

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By Melissa Patrick
Kentucky Health News

A House bill to educate the public about how to safely dispose of hypodermic needles easily passed was hit with a surprise amendment that would require a one-for-one needle exchange at needle exchange programs.

Rep. Mike Denham
The amended bill, which passed at the March 9 Senate Health and Welfare Committee meeting and now goes to the Senate floor, didn't set well with its sponsor, who said the amendment took him by surprise.

"At first blush, I have real problems with it," Rep. Mike Denham, D-Maysville, said in an interview. He said the amended bill would likely not pass in the House, but said he would review it and then decide whether to concur or not. He said he had already received emails and texts from his constituents telling him they did not support the committee substitute.

The original bill, House Bill 160, would require the state Department for Public Health to establish guidelines for disposal of hypodermic syringes, needles and other sharps used for home medical purposes and disseminate educational materials to pharmacies and the public. It was written to increase the safety of landfill workers who are at constant risk of being stuck by improperly disposed of needles.

Sen. Denise Harper Angel, D-Louisville, while supporting the original bill, voted no on the substitute and told the committee that the Louisville needle exchange program does not have a one-to-one requirement and is working well. "The effort here is to diminish disease," she said.

Sen. Ralph Alvarado
Needle exchanges were approved as part of an anti-heroin bill in 2015. Republican Sen. Ralph Alvarado, a Winchester physician, who voted for the substitute, said in an interview that the intent of the law was to only allow a one-to-one needle exchange. He said many senators would have voted against that measure if they had known exchanges did not have to be one-for-one.

The Office of the Attorney General released a formal opinion Dec. 18 that said needle-exchange programs in the state do not have to have a one-for-one exchange. The opinion was requested by state Senate President Robert Stivers of Manchester, who along with other Republicans, also say that the intent of the law was a one-for-one exchange.

Alvarado criticized then-Attorney General Jack Conway's opinion: "That wasn't how it was presented originally to the state." He added, "The one-for-one encourages more interaction, more opportunity for involvement for the provider to provide treatment for their disorders, to test them for communicable diseases and that sort of thing."

Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, said in an e-mail that not requiring a one-to-one exchange has been proven to reduce the spread of HIV and hepatitis C, which is the intent of the program. Kentucky leads the nation in hepatitis C and suffers more than 1,000 drug overdose deaths a year.

�A one-to-one syringe exchange implies that no needle sharing is occurring," Moyer wrote. "We know that is not the case. The �needs-based negation model� is a best practice across the country. Our goals are to prevent the spread of HIV and hepatitis C in our community and to stop intravenous drug users from sharing and reusing needles. The program is working! Participants continue to return used and potentially infected syringes for sterile ones."

She added, "Our latest figures indicate that one syringe is being returned for every 1.3 syringes distributed among returning clients. Overall the rate is 1 to 1.7. We have more than 2,000 participants and the number continues to grow. We�ve tested approximately 500 for hepatitis C and HIV and referred those who test positive to medical treatment. We�ve also referred 143 individuals to drug treatment."

Alvarado said, "Even if the health departments want to do it this way now, that is not how the law was intentionally meant to be passed."

Needle-exchange programs operating or approved in the state are in Jefferson, Fayette, Grant, Pendleton, Carter, Elliott, Franklin and Jessamine counties.

Wednesday, 9 March 2016

Princess Health and Low-income workers say to keep Kynect and Medicaid expansion; advocates wonder how new insurance exchange will work. Princessiccia

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By Melissa Patrick
Kentucky Health News

As Republican Gov. Matt Bevin's administration moves forward with plans to dismantle Kynect, the state's health insurance exchange, several working Kentuckians shared stories at a news conference March 8 about how having affordable health insurance through Kynect and expansion of Medicaid has changed their lives, and asked the governor to reconsider his decision.

Jesus Gonzalez and Troy May
"For working Kentuckians in particular, Kynect is much more than just a website. It is a one-stop-shop for coverage that allows workers, students and caregivers an easy and seamless way to not only enroll in coverage, but to move easily between Medicaid and private insurance as their incomes fluctuate," said Emily Beauregard, executive director of Kentucky Voices for Health, an umbrella group of health-care lobbying organizations.

Beauregard said that contrary to popular belief, most newly insured Kentuckians are low-income workers who didn't have health benefits.

One of the part-time workers from Covington, Troy May, who is also a full-time graduate student at Cincinnati Christian University, explained how getting insurance through a qualified health plan on Kynect has allowed him to pursue a new career, work part-time and also care for his 90-year-old grandmother. He said federally subsidized insurance from Kynect "fills in the gap" between his life now and when he will eventually work full time and get work benefits.

"Every time that Gov. Bevin talks about dismantling Kynect," May said, "it's like a punch in the stomach." He said the same coverage he gets on Kynect will be $200 more a month, with higher deductibles and co-payments on the federal exchange, which he says is not affordable.

"So this idea that we can easily move to a federal exchange and it not impact Kentuckians negatively is just flat out wrong," he said, adding later, "I beg Governor Bevin and the Republicans in the state not to dismantle Kynect."

May said he is a Democrat who comes from a family of Republicans, many of whom have signed up for health insurance through Kynect and have asked him, on their behalf, to ask Bevin to reverse his decision.

Another worker, Jesus Gonzalez, a single father and a food server in a Lexington restaurant, signed up on Kynect for the Medicaid expansion, which allows those with incomes up to 138 percent of the federal poverty line to enroll. He said that he had not had health insurance for the past 10 years because he couldn't afford it and shared stories about the "peace of mind" he now has because he can go to the doctor and the dentist. He said this has "made a huge difference in my life."

"It is really important that we do what we can to save and keep Kynect and Mediciad expansion in Kentucky," Gonzalez said. Bevin has said the expansion won't be sustainable once the state has to start paying a small part of the cost next year, and is negotiating changes in the program with the federal government.

The conference was sponsored by Keep Kentucky Covered, a coalition that is focused on sustaining access to affordable health coverage in Kentucky through Medicaid expansion and Kynect.

Pleas to save Kynect are likely falling on deaf ears. Bevin campaigned on closing Kynect, and has said it is redundant because there is a federal exchange that does the same things.

Advocates argue that Kynect provides one website to sign up for subsidized insurance and Medicaid, while Bevin's new model will require two websites, one called Benefind for Medicaid and other public-assistance programs, and the HealthCare.gov for federally subsidized insurance.

Health Secretary Vickie Yates Brown Glisson told a House budget subcommittee last week that the state would move to a "supported state-based marketplace" that will allow it to keep some control over review of insurance plans and handle insurance-company grievances, but the actual enrollment and any consumers' eligibility appeals will be handled by the federal exchange. Consumer grievances will be handled by a state-federal partnership.

Glisson said she didn't know how many Kynectors, or health-insurance navigators, will remain. Beauregard and Rep. Joni Jenkins, D-Louisville, chair of the House Budget Review Subcommittee on Human Services, voiced concerns about the abilities of local offices of the Department of Community Based Services to handle the 1.3 million Kentuckians on Medicaid.

"They are already overburdened and overwhelmed with the amount of work that they are doing and facing budget cuts," Beauregard said. "I worry that people are going to have a harder time getting enrolled in coverage and keeping their coverage, and getting the assistance they need when they run into an application problem or need to ask a question."

Wait times at DCBS offices average 2 hours and 44 minutes, while wait times at the Kynect call center are 2.15 minutes, according to the education and outreach director at Kynect, Beauregard said.

Jenkins voiced the same concerns in a separate interview, also noting the importance of Kynectors who not only help people sign up for health insurance, but also help them access health care after they sign up.

"I would hope that our state's goal was to not only get people signed up, but (to also) connect them with health care," Jenkins said. Later adding, "I find it so interesting that we are going to do away with a Kentucky-made product that is working so well, that pays for itself, and that was paid for by federal dollars and it's like letting big brother come down and -- so, that is very interesting,"

Glisson told the subcommittee that she believed there would be some funding for Kynectors. She also said the county-based employees of her cabinet could help people get to the federal exchange if they don't qualify for Medicaid.

But even if some Kynectors are included in this new model, the number of them will be determined by the number of people on the federally subsidized plans, and not include funding for Kynectors to help those on Medicaid, Beauregard said, "so you will also see a difference in the level of service you get if you enroll in Medicaid verses enrolling in a private plan," she said.

"What is really important right now is to ensure that we have an enrollment system that works as well or better than Kynect moving forward for all of the Medicaid recipients in Kentucky," Beauregard said. "And what that means is that we have to make sure that we have the capacity, whether that be at the Kynect call centers or in DCBS, to help these individuals enroll in coverage and to make sure that we are not creating barriers that translate into our uninsured rates going higher again or people loosing access to the care that they critically need,"
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