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February 26, 2018

Lobbying on cigarette tax ramps up, with foundation's ads and tobacco firm's use of farmers, retailers and paid media report

RAISING CIG TAXRAISING CIG TAXRaising the state cigarette tax $1 a pack is an active idea among members of the Ky. General Assembly

FRANKFORT, Ky. -- If activity by lobbying interests is any indication, the idea of raising the state cigarette tax $1 a pack is an active idea among members of the Kentucky General Assembly.

The main group advocating the tax increase, the Foundation for a Healthy Kentucky, reported spending more than any other lobby during the first month of the session. Its total of $100,240 was not far ahead of collective spending by tobacco companies that oppose the tax hike, which totaled $95,218.

The leading pro-tobacco spender, at $44,643, was Altria Client Services, a subsidiary of Altria Group, which includes Philip Morris USA, the nation's largest manufacturer of tobacco products.

This month, Altria spent an as-yet-undisclosed sum with Commonwealth Radio Reports of Louisville, which distributed a 45-second audio report to Kentucky radio stations about tobacco farmers and retailers lobbying legislators against the tax increase. The report did not say who sponsored or produced it.

Richard Farmer, the reporter and company owner, told Kentucky Health News that Altria brings tobacco farmers to Frankfort every session, but this year added retailers. That indicates the stakes are higher; in addition to the foundation's campaign, the state faces serious revenue problems.

The foundation is also using paid media. It has laid out more than $98,500 for an advertising campaign set to begin Monday, Feb. 26, Marcus Green reports for Louisville's WDRB. The foundation is staffing the Coalition for a Smoke-Free Tomorrow, comprising more than 150 groups and individuals.

“It will be a multimedia campaign,” Bonnie Hackbarth, spokeswoman for the foundation and the coalition, told Green. “We will be using billboards, cable TV, digital, and we will be focusing on the health benefits that can be achieved through a $1 or more increase on the tax on cigarettes.”

Hackbarth told Green that the campaign will focus on the health benefits of quitting smoking. Kentucky's smoking rate of 25 percent "trails only neighboring West Virginia," Green notes.

"Hackbarth said the coalition, whose members include health, business and other groups, does not expect that a standalone bill raising the cigarette tax will pass during the current session," Green reports. "But she said it’s possible the measure could be added during budget negotiations or approved in a special session on tax reform. Advocates estimate a $1-per-pack cigarette tax could generate more than $266 million for the state each year while also reducing smoking-related illnesses."

Hackbarth said of the ad buy, “This is the first wave and we will continue until we will be able to win.”

In his report, Farmer said, "Opponents say the tax hike would unfairly burden those least able to pay, the nearly 48 percent of low-income Kentuckians who smoke, and it would hurt the family farm, according to Christian County farmer Robert Gray," who said tobacco prices are stable, unlike those for other farm products.

Altria's allies also argue the hike would be "counterproductive," Farmer reported, because "60 percent of states recently increasing cigarette taxes failed to meet revenue projections. Growers pointed out that higher taxes would drive smokers across borders to buy cigarettes, harming Kentucky convenience stores, which derive more than a third of their sales from cigarettes." Dan Hartlage of Guthrie Mayes Public Relations in Louisville, which works for Altria, was asked the source of that data and what "recently" meant, but didn't provide the information.

Raising the tax $1 a pack would make it $1.60, the same as in Ohio but much higher than the 99.5 cents in Indiana, the other state that shares a major metropolitan area with Kentucky. The rates in other bordering states are $1.98 in Illinois, $1.20 in West Virginia, 62 cents in Tennessee, 30 cents in Virginia and 17 cents in Missouri; the last two are the lowest in the nation.

Foundation President and CEO Ben Chandler said in an email that tobacco manufacturers are “hiding behind farmers,” who “get about 3 cents per pack of cigarettes for their tobacco. Yet the health-related costs are about $35 per pack. And every household in Kentucky pays about $1,200 in extra taxes each year to cover those health costs. We’re grateful that lawmakers are beginning to understand this message, and will keep working until we can announce we’ve kept our promise to make Kentucky healthier by reducing smoking and exposure to secondhand smoke.”

Posted by Al Cross 

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

LAWRENCE CO. HEALTH DEPT. is participating in the program and has run a media campaign on many tobacco concerns.


February 14, 2018

States expand authority of nurse practitioners and physicians assistants to increase health care in rural areas

Can get waiver to prescribe opioid maintenance drugs

The shortage of doctors and drug treatment in rural areas hamstrings efforts to fight the opioid epidemic. Medication-assisted therapy, which requires a prescription, is the most effective treatment. The Drug Enforcement Administration announced in late January that nurse practitioners and physician assistants can get a waiver that allows them to prescribe and dispense opioid maintenance drugs. But lawmakers in several states have gone a step further, seeking to expand the scope of practice for nurse practitioners and physician assistants in rural areas where there is often no doctor.

In Georgia, Republican Sen. Renee Unterman, chair of the Senate health committee, has introduced a bill that would give rural nurse practitioners more latitude to treat patients. Nine of the state's 159 counties have no physician, and dozens more have no pediatricians or obstetrician/gynecologists. "Proponents argue expanding the scope of practice for nurse practitioners could help fill in the health-care gaps in a growing state with increasing needs, especially with primary care. Nurse practitioners can also specialize in certain areas, such as pediatric care or mental health treatment," Jill Nolan reports for the Valdosta Daily Times.

In April 2017 the Pennsylvania Senate passed a bill to let nurse practitioners to practice on their own after fulfilling a three-year, 3,600-hour formal agreement with a physician, Jan Murphy reports for Penn Live. "There are not enough doctors willing to practice in smaller communities and as older doctors retire, fewer new doctors are coming in to replace them," said the bill's sponsor, Republican Sen. Camera Bartolotta. "Thankfully, there is a solution that holds the promise of easing this looming health care catastrophe."

Texas passed two related bills in 2017: one that allows nurse practitioners in under-served areas to see Medicaid and Children's Health Insurance Plan patients without a doctor's supervision, and one that allows APRNs and physician's assistants to sign death certificates. Nurse practitioners had protested having to pay up to six-figure contracts with doctors that would allow the nurse practitioners to treat patients and write prescriptions, Mariana Alfaro reports for The Texas Tribune.

Written by Heather Chapman Posted at 2/14/2018 


February 19, 2018

Anthem makes several exceptions to its controversial policy of denying payment for ER visits it deems non-emergency

Responding to complaints from legislators and health-care providers, Anthem Blue Cross Blue Shield has added several exceptions to its recently established policy of not paying for emergency-room visits if it determines there was no emergency.

The policy first took effect in Kentucky, Missouri and Georgia; "Ohio, Indiana and New Hampshire were added to the program in January, after the new exceptions were already in place," Leslie Small reports for FierceHealthcare.

The exceptions include patients who:

*  are sent to the ER by another provider, including an ambulance
*  visit an ER between 8 p.m. Saturday and 8 a.m. Monday, or on a major holiday

*  are younger than 15
*  live more than 15 miles from an urgent care center
*  are traveling out of state
*  receive any kind of surgery
*  get intravenous fluids or IV medications, or an MRI or CT scan
*  have an ER visit associated with an outpatient or inpatient admission

"Anthem said the changes went into effect Jan. 1," Shelby Livingston reports for Modern Healthcare. "It will apply the exceptions to any previously denied claims."

The company said in a prepared statement, “Anthem stands by our belief that emergency rooms are an expensive place to receive routine care. The costs of treating non-emergency ailments in the ER has an impact on the cost of healthcare for consumers, employers and the health care system as a whole.”

The changes did not satisfy the American College of Emergency Physicians. "This is still a fundamentally flawed policy,” Laura Wooster, the group's associate executive director of public affairs for the American College of Emergency Physicians, told Small. “Making fixes around the edges doesn’t end this dangerous policy that’s really going to scare patients away from going to the ER or even considering going to the ER.”

Wes Brewer, former president of ACEP's Kentucky chapter, told Lisa Gillespie of Louisville's WFPL, “We have hundreds of cases where people with conditions, where I don’t know in what universe you wouldn’t think they’re emergencies, have been denied.”

Small reports, "Anthem’s program was meant to deter members from using the emergency room for illnesses or injuries that aren’t life-threatening. But critics say patients shouldn’t be forced to self-diagnose, warning that the new policies will encourage people to avoid seeking care for serious medical conditions out of fear that their claim will be denied."

Shannon Muchmore reports for HealthcareDive, "Anthem has said its program denies a small percentage of claims, but the change in policy signals the payer may be worried about the backlash, including from patients who have gone public with denied claims.

Posted by Al Cross at 9:59 AM

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

February 13, 2018

My name is Rosanne. I’m 30 years old. My sobriety date is December 13, 2016. This is my story...

I grew up in a home where my mother was the provider for me and my brother. She worked very hard to make sure we had the things we needed. My father was there but that’s about it. He didn’t help my mother provide for us and never showed us any positive attention. The only attention I received from him was physical or mental abuse. I was basically left to figure out how to feed and take care of my little brother while our mother worked. I now understand that he was doing the best he knew how to at the time. I spent most of my time with my grandmother to escape what was going on at home. When I was 10 my parents got divorced and my dad basically disappeared out of my life. The first few months I was going with him for visitation, but the visits kept getting fewer and fewer until there was no contact at all. This developed into what I now recognize as an abandonment issue in my life and created a void I would spend the next 15 years of my life trying to fill.

When I was 13 I was introduced to marijuana and began smoking it daily. I thought it was solving my problems, so to speak, because I wasn’t feeling my emotions anymore, until it wasn’t. At the age of 15 I was introduced to prescription pain pills. It numbed the pain with those for a while. At 16 I met my ex-husband and at 17 we were married. I was on top of the world. I felt like I had finally found something / someone to fill that void and everything was going to be ok, again until it wasn’t! So I gradually began using prescription pain pills again to “deal with life” I guess it’s safe to say I had developed an unhealthy habit of numbing my emotions and pretending they didn’t exist. My addiction quickly escalated and later resulted in a divorce. He was never in addiction and couldn’t understand the hold it had on my life.

After the divorce the pain pills just weren’t doing the job anymore and I began searching for something else. At this point I felt totally hopeless and like I wasn’t good enough for anyone or anything. Here I was 25 years old, my father had more or less abandoned me and I had failed terribly at being a wife. Shortly after my divorce I met husband #2. He was also in addiction and as sad as it is I thought, 'well at least I don’t have to hide getting high anymore, we can get high together and it’s all going to work out this time'. That’s the kind of hold addiction had on my life. It’s sad, but true. Not long after we were married we were introduced to methamphetamine and it didn’t take long for us to figure out how to make it. Needless to say, 6 months in we were both mentally gone and our marriage fell apart. By this time I had become an IV user and was so mentally unstable that I honestly couldn’t determine what was reality and what wasn’t. This ultimately resulted in numerous trips in and out of jail and eventually felony charges. I accepted drug court as a result of this felony charge but still couldn’t quite get a grip on my addiction.

I was put back in jail a couple of times for failing drug tests but I see now that it was all a part of God’s divine plan. My last trip back to jail resulted in drug court offering me rehab. I was hesitant at first, but knew I desperately wanted to change and wanted my life back. I arrived at Beth’s Blessing on January 3, 2017. I walked in those doors broken and hopeless but yet wanting so desperately to change. I didn’t know how, or if it was even possible, but I was willing to give it a shot. While I was completing treatment I kept hearing about how others were surrendering their lives to God and what a difference it was making in their lives. It planted a seed and got me curious, but I couldn’t help but think how could God ever forgive me? How could He ever love a mess like me?! All I kept hearing though was how much God loved me and that it didn’t matter how far I had run, He was waiting with arms wide open. All I had to do was surrender.

I’ll never forget the day that God got ahold of me in that little church in Jackson County. I hit my knees and completely surrendered everything to Him. In that moment I was set free. My life has completely changed for the better since that moment. God has restored things in my life I would have never imagined and gave me my life back! When I first walked into treatment the officer, who is actually our local jailer that transported me from jail to treatment walked me in the doors and said, “You can do this, anytime you feel like you can’t just remember,” he pointed to a verse on the wall. It was Philippians 4:13 “I can do all things through Christ who strengthens me.” That stuck with me and I still use it today to get me through things that seem impossible.

Now I have no abandonment issues. I have a heavenly Father that loves me more in one moment then any human could in one lifetime. I’ve found the most amazing fill for that void and that’s the Holy Ghost. The Bible says in 2 Corinthians 5:17 NLT, “This means that anyone who belongs to Christ has become a new person. The old life is gone; a new life has begun!” So although my past will remind me, it will never define me.

What was your aha moment?

When I was sitting back in jail after just getting released 8 days prior. At that point I was sick and tired of being sick and tired I knew it was time to change.

Feelings and emotions in active addiction:

I was emotionless, heartless, and didn’t care about anything except my next high. I was basically just existing.

The driving force that keeps me going when times get tough:

God and my family. Also looking back at where God has brought me from and how much He’s done in my life since then.

Advice for the addict still struggling?

There’s always hope! You are worth it!

What obstacles or road blocks have you faced in your recovery?

Losing my grandmother; it completely turned my world upside down.

What is something you want people who never struggled with addiction to know?

We are not bad people, although we make bad choices and sometimes do bad things. Please understand that addiction controls a person’s life in ways you couldn’t imagine. We are good hearted people fighting battles most don’t understand.

What advice do you have for family members of a person in addiction?

Don’t give up! Be careful that you’re not enabling but never give up hope! Let them know how much you love them even when it seems hard to like them.

Closing Thoughts

Nobody is ever too far gone for God’s grace and mercy. No matter what you’ve done or who you used to be He loves you so much more then you can even begin to imagine. He is always there with arms wide open.

If you or a loved one is struggling with addiction, please call Addiction Recovery Care at 606.638.0938 or visit them on the web at


There is hope. There is help.