A bill that would create panels of experts to review lawsuits against health-care providers is going nowhere, again.
State Senate President Robert Stivers said Friday that he and other leaders of the Senate's Republican majority sent Senate Bill 6 back to committee because last week's special elections continued Democratic control of the House. They did likewise with a bill for a "right to work" law that would ban union membership or fees as a condition of employment.
�The reality is the House does not see as the majority party in this Senate does, that right-to-work would even be another tool that could increase and expand on job recruitment and retention,� Stivers said. �The other thing is we�ve had Senate Bill 6 sitting on the board for quite some time. But, because of the elections two weeks ago, the consequences are, they would pass this chamber but die in the House.�
Today was poised to challenge everything about my plan. And it did. If you read last night's edition, you know how it started. Today started last night with what I felt was a well justified nap--and to a degree it was, but would have been better had I held on a little bit longer, finished a few things and made it for the entire night--not a nap. Instead, what happened as a consequence set up a day that required sharp awareness on very little sleep.
I couldn't go back to sleep last night. That nap was solid. It was restful in every way. It totally energized me to the point of not being able to go back to sleep until after 4am. I tossed and turned--gave up, listened to an NPR podcast--turned it off, tried to shut down---still nothing. And the later it became, the more worried I was about today. I had the alarm set for 4:45am. I was up for the day shortly before 5am.
Had this been a normal day, I likely would have opted for a sick day. But we have a studio colleague out, recovering from knee replacement surgery--and I'm covering, the same as she would do for me in a similar situation. Short staffed means very little room for sick days except in the most extreme cases. And we had a big location broadcast involving two radio stations broadcasting simultaneously for four hours straight--eight breaks an hour, I had to be on top of this. Honestly--I was seriously concerned about my ability to make it all work out, today.
Before the wrong impression is communicated here--let me be clear--Today's story isn't about how strong I am or how I somehow pulled it together despite all the odds against me. No. I'm NOT the hero in this story.
The hero was the plan. It started first thing during my morning spiritual dialogue. It continued with a well defined food plan. It was supported by like minded support buddies--at the ready, communicating with me at various times throughout the day. I was tired, but sharp--which is a strange combination--and I stayed aware of the potential danger lurking if I didn't embrace the rails of my plan on this challenging day.
The food plan was important. With lunch provided at the location broadcast--an assortment of cookies, chips and high quality hotdogs--all premium items, and free to staff and customers--but not on my food plan--not free to me...I needed my plan. I planned, prepared and packed my lunch--and it was just what I needed to help me through. I leaned heavily on coffee to help me out--and although the eight breaks an hour--which translates to roughly 24 minutes of constant talking per hour--12 minutes for each station--I still made a few quick support texts during. When the broadcast wrapped--I had spent about an hour and thirty-six minutes of total talking between the two stations--in a four hour period. That's a challenge even for any well rested person. I'm grateful my voice somehow held up. That was an answer to a prayer, for sure!
I likely overcompensated on my performance. I couldn't allow anything less than a good broadcast considering the investment the client had made. And it worked well. The broadcast was a success--even acknowledged by the client in that way. And as it drew to a close, I was getting much closer to being able to get home and finally grab some more rest.
I exchanged the station vehicle for my own, made a quick grocery store run for a couple of items I needed for dinner--and another coffee, then headed back to the studio to finish up whatever needed finished in the production studio.
I made it home a little after 4pm. I quickly caught up with the teleconference support group exclusive facebook page and prepared for two quick one-on-one phone appointments. I tried to postpone the second one, but it was extremely urgent--so I went ahead and proceeded, knowing that I was minutes away from the nap I had my eye on all day long. This upcoming nap wasn't one I could regret in any way, shape or form--because the rest of my weekend is clear--no work duties--no stand-up performances---just catching up on rest and concentrating on feeling better.
"Have you been drinking?" Obviously, by the time I reached that second call--I was starting to show significant decline in speech and clarity. No, in answer to the question on the other end of the phone--I hadn't been drinking anything but water and coffee all day. I'm not a drinker, thank God.
But I'm a food addict deluxe. And for that reason, it took this high level of care today to help me make it through. I know me--I know, without the rails of support--from the spiritual, to the food planning--to the support connections--I wouldn't have had a very good day at all. It could have been a complete disaster.
The plan was my hero.
The wrap up to this day was refreshing. I woke after an hour and a half nap--ready for a great Friday evening. I enjoyed the best cup of coffee--and settled into preparing an amazing dinner. I almost talked myself out of a late workout. But I had made an accountability commitment to get it in at some point after a good nap...and I had that good nap---and now, a great meal--and honestly, although I could have easily dismissed the workout tonight and got back in there tomorrow, I decided to get to the gym and enjoy it.
Now--had I been ready to drop back into bed--different story, but I knew I'd be up anyway--with or without the workout--and mentally, the workout simply solidified the unlikely structure of a day that easily could have been an unstructured mess of chaotic destruction. Is that a little over-dramatic? Maybe a touch. But not too far from reality.
I know myself very well. And I know--each day for me, isn't guaranteed. My success each day requires an importance level on the highest. And when my actions from the previous night are not in support of this importance level for the next day---it requires me to quickly get a grip--hold on, say a few prayers--and carefully proceed, guided by the rails of this plan. The plan that provides so much freedom in its embrace. It's interesting how my perspective was once focused on how much I thought the plan had to be restrictive or somehow burdensome and now it's a source of clarity and freedom. Very interesting to me. Very blessed. Very grateful.
Bills to continue the Kynect health-insurance exchange and the state's current expansion of the federal-state Medicaid program passed out of the House Health and Welfare Committee March 17, starting a series of legislative votes on health reform that once seemed unlikely.
House Speaker Greg Stumbo said he expects the bills to pass the Democratic-majority chamber, even though Republicans in the fall elections could cast votes as support for "Obamacare," the federal reforms under which then-Gov. Steve Beshear created Kynect and expanded Medicaid.
�There�s never really been a debate on this issue,� Stumbo said. �There�s not been a true letting of the facts, if you will.�
Six days earlier, Senate President Robert Stivers had more or less dared Stumbo to move the bills, whose sponsor had said he did not expect them to pass the Republican-controlled Senate, in order to "have a full, fair debate on the issue" and see where legislators stand on it.
House Bill 5 would require the state to keep operating Kynect, which Gov. Matt Bevin is starting to dismantle or transform. In his campaign, Bevin vowed to abolish the exchange, saying it did nothing that the federal exchange does not. Recently his administration announced that it would continue operating a state-based exchange but use the federal exchange for enrollments.
"They're being pushed into what everyone calls Obamacare, and they don't want that," Stumbo told reporters.
House Bill 6 would keep the current expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. Bevin is negotiating with federal officials to change the program, saying it will not be sustainable once the state has to start paying part of the cost.
Rep. Darryl Owens
The committee approved the bills along party lines. Their sponsor, Rep. Darryl Owens, D-Louisville, said he filed them because "It is important for people to understand that there are those of us in this legislature that want to continue expanded Medicaid, that want to continue Kynect."
The exchange is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which reform made unecessary. Approximately 1.4 million Kentuckians use Kynect, all but about 100,000 of them on Medicaid.
Kynect was started with federal grants. Rep. Robert Benvenuti, R-Lexington, argued that the state must include that $273 million when considering its cost. "I think most people in this room, most people in Kentucky, pay federal taxes as well, so this whole notion that there is a great federal money tree in which we can go pick off of and build things is just not correct," he said.
Owens replied, "I'm not saying it's a money tree, I'm just saying it's a grant that the federal government gave the states if they wanted to develop their own system," Owens said. "And I think the thing we miss when we talk about that is we have a great system; we have the best system in the country."
Rep. Tim Moore, R-Elizabethtown, whittled the definition of Kynect down to a business that advertises and markets Medicaid and health insurance to Kentuckians, and asked, "How do you spend that kind of money to go out and build a marketplace for soliciting folks to do what would be in their own interest anyway?"
Cara Stewart of the Kentucky Equal Justice Center said the marketing has value because it has created a brand that Kentuckians recognize and trust, allowing them to know where to go to get health insurance. She said Kynect runs seamlessly to help Kentuckians shop and enroll in coverage for both Medicaid and federally subsidized insurance plans, unlike Bevin's approach.
She said later that it now takes two minutes to reach customer service on Kynect and two hours on Benefind, which is operated by the state Department of Community Based Services. "We are radically changing the quality of service to Kentuckians," she said.
Rep. Tim Moore
Moore said he was glad the bills would be voted on because Kynect and the Medicaid expansion had been created through "dictatorship," not "the will of the people." Beshear acted under a state law that requires the government to get as much federal money as possible for Medicaid, and he used his broad executive powers under the state constitution to transform the high-risk pool into Kynect.
Moore said Bevin's election showed public opinion on the issue. However, a poll in November, after the election, showed Kentuckians supported the Medicaid expansion by 3� to 1 and keeping Kynect by 2 to 1.
Democratic Rep. David Watkins, a retired physician from Henderson who voted for both bills, said, "It is kind of sad that our citizens don't pay attention to what our politicians are saying because they do have consequences."
Democratic Rep. Joni Jenkins of Louisville, chair of the House Budget Subcommittee on Human Services, said her panel's hearings convinced her that the state needs to keep it. She said there is value in having one system for Kentuckians to access health insurance, and to have Kynectors, who not only help people access health insurance, but also help them access health services.
Emily Beauregard, executive director for Kentucky Voices For Health, said after the meeting that navigating health insurance is difficult, especially for those who have never had it. "We need to help connect people to a source of care and help them understand how to use their benefits and that's what we've been able to do through Kynect," she said. "Coverage alone is not going to solve Kentucky's health issues."
Benvenuti said after the meeting, "There are various ways to get people to health care and creating a huge governmental system that is duplicative of the federal system is simply not the best use of our dollars."
As for Medicaid, Benvenuti said, "We've got to create a system where everybody who gets health care through an expansion population, or however you want to define it, has skin in the game and is responsible ultimately for their own health care."
I really pushed myself today and I paid for it with my voice. The sore throat wasn't as bad, but the more I used my voice in the course of a busy workday, the quicker it deteriorated--to the point of significant decline. For someone in my profession, this is a serious issue! I've been taking it easy--and maybe a little too easy, tonight--when what was to be a short nap once again turned into something bigger, completely wrecking my plans for a workout at the gym followed by an early bedtime. My voice did need the rest. But I know, it would have been better, all together--not broken up into two long naps, which is basically what I'm doing.
Food wise, I handled today very well. It was well planned, on point and felt really solid. I had a midday broadcast--and I'll have another tomorrow that's even more challenging by being twice as long with four times the amount of on-air breaks. Four times. I'm hoping my throat/voice can meet the challenge. The steroid shot at the urgent care did help, I'm certain.
I was originally scheduled for fasting blood work this morning. That appointment was made long ago--and before today's scheduled midday broadcast. The smartest move for me, today, was deciding to reschedule that blood work for early next week. As it turned out--I had plenty to do after my morning show and before my location broadcast--and a morning lab appointment wouldn't have fit well in the schedule.
I'm overwhelmed with excitement about the next ten week session of the support group I'm co-facilitating with Life Coach Gerri and Kathleen Miles. We're almost completely full. The last check revealed three open spaces for our Tuesday night conference call. That's it! The Tuesday night session is at 7pm Central/8pm Eastern/5pm Pacific.
If you're interested in discovering the difference a concentrated accountability and support team can make, I highly recommend you joining us! The call is once a week. But the majority of the accountability and support takes place on our secret Facebook page that's visible only to group members. Our Facebook page combines Monday and Tuesday night group members, too! That's where we all interact daily. In other words--this group is so much more than a weekly call! Couple that with text & call spot-support with facilitators and fellow team members--and it's a fairly comprehensive well-rounded approach.
The group is made up of members at every mile marker along this road. Some are just getting started, some just hit goal or are near goal and are now making the transition into maintenance mode. Wherever you are--100, 200 pounds or more to lose or 40, or even less--this group can be a fantastic tool for you! It's proven successful for many members, past and present. Here's the link for the Tuesday night registration: http://lifecoachgerri.com/events/0322-accountability-support/ Also--email me directly with any questions: transformation.road@gmail.com
It's Throwback Thursday!! The Tulsa World newspaper has included me in a few feature stories over the years. The stage shot below goes all the way back to a story they published in 2001 about my stand-up comedy and more specifically about New Years Resolutions. Years later, they published a big spread about my blog and weight loss. They've been very kind to me! "Stand-Up Comedy-Then and Now" #TBT Side By Side comparison. Photo credits: Tulsa World and Tera Leiter.
I don't have very many pictures of me doing stand-up at over 500 pounds. This is one of the very few--or two, that exist--or that I know of existing. I just wasn't too open about pictures at my heaviest--which seems strange considering the amount of before pictures I seem to have at the ready. The excessive amount of before pics are largely due to some wonderful family members who loved/love taking pictures--even when I wasn't exactly thrilled about being in the pictures. Now I'm thankful for what they've contributed to my archives--namely my Aunt Kelli, whose contributed the most. Here's a request--any friends and family with old before pictures of me on stage doing stand-up, please let me know! I'd love to have a copy.
I better attempt to go back to sleep. I feel somewhat justified in my destructive approach to my schedule this evening in the name of taking care of this sickness thing. Of course, this could be the side of my brain that tries to rationalize all potentially negative choices into a nice pretty little box. Too bad I can't take tomorrow off, or I would. But I'll make it fine--and the weekend is fairly clear of work responsibilities--so I'll have more time to catch up and take extraordinary care.
Air ambulance services have enabled rural Kentuckians to get advanced emergency care more quickly, but there's a catch.
"Increasingly, the service also can mean the difference between getting well at a price you can afford or at a price that could push you over a financial cliff," Trudy Lieberman writes for Rural Health News Service. "Air ambulances have become the centerpiece of a nationwide dispute over balance billing, a practice that requires unsuspecting families, even those with good insurance, to pay a large part of the bill."
On Wednesday, March 16, the state House Banking and Insurance Committee approved a bill calling for a study of air-ambulance charges. House Bill 273 was sponsored by Rep. Tom McKee, D-Cynthiana, "after a constituent of McKee�s was transported to the hospital via air ambulance after a fall, but it was an unexpected bill for thousands of dollars not covered by insurance which really knocked him off his feet," Don Weber reports for cn|2's "Pure Politics."
Rep. Tom McKee
"McKee says having more information about emergency care transportation may have allowed the individual to avoid the high cost," Weber reports, quoting him: �I have learned in looking at it that certain air-ambulance companies provide a subscription service for perhaps as little as $50 a year, that you can have coverage to know if you need to be transported, the full cost would be paid. As we move forward, I think we�re going to learn a lot more to at least inform people.�
McKee said the charges, which can run well into five figures, may seem huge �but those air-ambulance companies have to keep people on duty and have to have a full crew ready to go at a moment�s notice. But, I think as citizens, we all need to know where we are in regard to being transported and things like we�ve learned, a subscription service could be available.�
Some committee members said they want to see if the charges are justified. �It�s nice to know what the cost is, $40,000, but if it only costs them $8,000 to do it,� said Rep. Steve Riggs, D-Louisville. �So we have to learn more than just what the average retail cost is, we have to also learn more about what the profit margin is.�
Lieberman reports that your air-ambulance bill may not be covered "because the provider is not in your insurer�s network," but "Sometimes it�s impossible to tell if a provider belongs to a network or not. When you are wheeled into the operating room, are you going to ask the anesthesiologist if he or she belongs to the hospital�s network? How many accident victims suffering from trauma are going to direct EMS workers to check if the air service is in or out of network before they�re lifted to a hospital? You can also get stuck even if the ambulance company is in the network. An insurance payment may not come close to covering the cost.
�Rates ambulance companies charge private patients are much more than they are charging to Medicare or Medicaid,� whose rates are too low to suit the companies. Consumers Union Programs Director Chuck Bell told Lieberman. �The air ambulance industry has grown rapidly, and prices have shot up a lot with some companies trying to make a quick buck.�
The sixth annual County Health Rankingsreport shows little change in Kentucky's top and bottom rankings, but there were a few surprises, with several counties showing up in the top 10 for the first time.
Marshall County was one, ranking 10th in both health outcomes and health factors, the rankings' two main measures. This is an improvement from last year's 26th in outcomes and 19th in factors. Bullitt County also moved into the top 10 for the first time this year, ranking sixth for outcomes, up from 27th.
Health outcomes include length and quality of life. Health factors contribute to outcomes and include four categories: health-related behaviors, clinical care, social and economic factors, and the county's physical environment. The rankings for each county are relative to other counties in the same state.
"Communities use the rankings to help identify issues and opportunities for local health improvement, as well as to garner support for initiatives among government agencies, healthcare providers, community organizations, business leaders, policy makers, and the public," says the report.
The County Health Rankings are a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
2016 Health Outcomes - Kentucky
The report is a general categorization of a county's health status. The rankings are arranged in quartiles, or four numerical classes, to de-emphasize the small statistical differences among closely ranked counties. Kentucky has 120 counties, in quartiles of 30.
The bottom quartile comprises almost entirely Appalachian counties, the only exception being Fulton, in the Mississippi Delta at the state's western tip.
Oldham and Boone counties continued to be the top two for health outcomes in the state, as they have been since the rankings began. Spencer County, ranked third, spent the last two years ranked 11th. Shelby and Scott counties are ranked fourth and fifth in outcomes. All are suburban, formerly rural, counties in the state's three major metropolitan areas.
The bottom 10 counties in health outcomes are all rural. They saw little change from last year, with Harlan (117) and Wolfe (119) being the only new additions. The bottom five counties in outcomes are Floyd, Harlan, Perry, Wolfe and Owsley (which has been ranked last for health outcomes every year, except 2013, when it ranked 102nd).
Counties that saw the greatest improvements in health outcomes were Livingston (LG on map), moving up from 70th to 35th; Trimble (TI), moving up from 56th to 27th; and Crittenden (CD), moving up from 64th to 38th. All these counties moved into a higher quartile with these ranking changes.
Morgan County, which for years had health outcomes far better than its health factors, saw the greatest decline in the outcome rankings, moving from 48th to 76th. It was followed by Russell, which fell from 61st to 88th; and Bracken, which dropped from 46th to 72nd. Russell County remained in the same quartile as last year, but the other two counties shifted to a lower one.
2016 Health Factors - Kentucky
The top five counties for health factors have all been in the top 10 before. They include Oldham, Boone, Spencer, Woodford and Campbell counties; Campbell had dropped last year to 12th.
The bottom five counties for health factors are Magoffin, Wolfe, McCreary, Breathitt and Bell, all in the Eastern Kentucky Coalfield.
Counties that saw the greatest improvement in health factors were Clark, moving from 53rd to 29th; Gallatin, going from 89th to 67th; and Crittenden, rising from 86th to 64th. Only Clark, just east of Lexington, moved into a higher quartile.
Counties that saw the greatest declines in health factors were Taylor , dropping from 30th to 58th; Butler, falling from 66th to 94th; and Union, dropping from 46th to 73rd. Each of these counties dropped into a lower quartile. Butler, Fulton and Carroll were the only non-Appalachian counties in the bottom quartile.
The report identifies "meaningful gaps" that exist between the best and worst Kentucky counties and suggests that policymakers look at these gaps as they search for ways to improve the counties' health, including: adult smoking, adult obesity, uninsured rates, preventable hospital stays, education levels, unemployment, children in poverty and income inequality.
The report says, "Every year, over 2,800 deaths in Kentucky could be avoided if all residents in the state had a fair chance to be healthy."
Rural residents are increasingly being transferred out of big urban hospitals to recuperate in rural hospitals, many of which are struggling financially and can use the business.
"We have seen trends of this around the state," said Elizabeth Cobb, vice president of health policy for the Kentucky Hospital Association, said in an interview.
Oregon's legislature voted recently to encourage the trend in that state, by appropriating $10 million for rural health-care improvements, with the largest part encouraging such transfers.
In Kentucky, Cobb said the transfers would have to make sense from procedural, convenience and financial perspectives, but when it works out it is great for both the urban and rural hospitals, and also for the families.
"Certainly when there is a treatment or procedure that will take a significant amount of recovery, it is a wonderful thing for rural Kentuckians to be able to transfer back to their community facility to finish off their recuperation," she said.
Oregon's program aims to create a more consistent patient population in its rural hospitals, which will help stabilize their funding. At the same time, the program will relieve pressure on strained urban hospitals, Chris Gray reports for The Lund Report.
Rural hospitals are struggling financially all over the country and often have inconsistent patient volumes, while urban hospitals struggle with reaching capacity, and often worry they might have to expand, Gray notes.
A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition and suggested that to survive, they might have to adapt to new business models, such as merging with larger hospitals or hiring them as managers, forming coalitions with other hospitals, or finding a health-care niche that hasn't been served, such as creating a partnership with urban hospitals to allow rural patients the ability to recuperate closer to home.
While it sounds like a "common-sense system," Gray reports that the program is costly to set up, between $4 and $7 million, but once it is up and running, and the hospitals learn how to coordinate, "it should be self-sustaining, since money from insurers, Medicaid and Medicare will follow the patient," according to an interim workgroup of rural health officials from Oregon.
A rural health physician told Gray that "local hospitals and healthcare access, along with good public schools, provide the backbone for a viable community when employers are looking to invest in a community," he writes.
