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Medicaid hearings in Bowling Green and Frankfort elicit nearly incessant criticism; third and final hearing in Hazard next Wed.

Supporters of the current Medicaid expansion sat on the front row of a packed hearing room in Frankfort.

By Al Cross
Kentucky Health News

Supporters were few and far between at the first two public hearings on Gov. Matt Bevin's plan for changes in the Medicaid program.

In Bowling Green on Tuesday and in Frankfort on Wednesday, critics of the plan said it would put too many obstacles between the poor and health care. A third and final hearing will be held in Hazard next Wednesday.

"What you're proposing to do here is more cumbersome than average folks find the insurance process now," said A.J. Jones of Louisville, identifying himself as a former Medicaid enrollee now on private insurance. He said in Frankfort that fiscal responsibility, a stated reason for the plan, is "important, but not when you're talking about people's health."

The plan would require enrollees to pay premiums of $1 to $15 a month, based on income. It would also require able-bodied adults without jobs to take job training or counseling, or do community service for nonprofit organizations.

Miranda Brown of Lexington, who helps the poor navigate the health-insurance system, said a homeless person she helped get on Medicaid told her that she would probably drop out of the program if she had to pay premiums.

Bevin and other Republicans say Medicaid enrollees need to have "skin in the game," but Harriet Seiler of Louisville said, "It's a concept that will scrape a pound of flesh from Kentuckians. . . . The sick, the poor and the unemployed are not naughty children who need to be incentivized, scolded or humiliated."

K.J. Owens of Louisville won applause from the overflow crowd in Frankfort when he said the plan "seems motivated by the concern that poor people are defective morally . . . that poor people just aren't trying hard enough. The people on Medicaid are in no more need of moral guidance than the governor and the people on the governor's staff."

Emotions peaked when Molly Shaw of Louisvile-based Parents for Social Justice predicted, "More people will be sick and more people will die. This waiver will kill people."

The plan is a request to the federal government for a waiver of normal Medicaid rules. Asked afterward to reply to Shaw's comment, Health Secretary Vickie Glisson said, "We're trying to maintain the expansion."

Bevin has said if federal officials don't approve his plan, he would end the expansion of Medicaid under federal health reform by his predecessor, Democrat Steve Beshear, that added to the rolls more than 400,000 Kentuckians earning up to 138 percent of the federal poverty level.

Emily Parento, who was Beshear's chief health-policy adviser, predicted that federal officials would not approve the work-oriented requirements or the plan's increase in premiums for enrollees between 100 and 138 percent of the poverty line. "This amounts to a penalty for poverty," she said, adding that the plan has "minimal detail" on the projected cost savings, other than reduced enrollment.

The only unequivocal endorsements of the whole plan, other than written statements from Republican legislators, came from the Kentucky Hospital Association and the state's largest hospital system, Baptist Health. KHA official Nancy Galvagni said the plan improves on those in other states "by using more carrots than sticks" to influence enrollees' behavior, and "does inject some personal responsibility into the system."

In Bowling Green, Diane Amos said her elderly mother couldn't afford premiums. (Daily News photo by Miranda Pederson)In Bowling Green, "A few speakers expressed support for smoking cessation programs or a pilot substance abuse treatment plan included in the proposal. But most of the about 20 people who spoke appeared passionately opposed to the changes, with comments that prompted frequent applause from the about 60 people at the hearing," reports Deborah Yetter of The Courier-Journal.

"Cara Stewart, a legal-aid lawyer who represents people on Medicaid, said Bevin’s application for a waiver conflicts with the federal government’s requirements for waivers," Yetter reports. "The goal generally, she said, is to enhance or expand coverage." Stewart said, “I don’t see anywhere in here where we’re increasing coverage I only see cuts in service and taking away access to care.”

The Frankfort hearing was part of a meeting of the state advisory council for Medicaid, chaired by nurse practitioner Elizabeth Partin of Columbia. She was among the speakers who questioned the removal of annual vision and dental exams from regular Medicaid coverage. "That's how you catch problems before they become huge problems," she said. Given the small cost, "It's not gonna break the bank either way, and it may help improve people's health."

The issue was also big in Bowling Green. “We’re No. 1 in toothlessness; so we’re not going to provide dental care for those who need it the most?” asked Chris Keyser, executive director of Fairview Community Health Center.

Franklin optometrist Steve Compton said optometrists often are the first to identify other health problems, such as high blood pressure or diabetes, during a routine eye exam. In Frankfort, Richmond optometrist Matt Burchett said optometrists discovered 15 percent of diabetics insured by United Health.

Under the plan, enrollees could earn coverage for vision and dental exams, as well as non-prescription drugs and gym-membership subsidies, by enrolling in job training, volunteer work or health-related classes.

Speakers at both hearings questioned the proposed six-month suspension of enrollment for failure to pay premiums. "It seems rather harsh," said council member Barry Whaley of Louisville, executive director of Community Employment Inc.

Bevin's deputy chief of staff, Adam Meier, noted that suspended enrollees could re-enroll sooner by paying premiums and taking a health-literacy or financial-literacy course. "We want to mirror commercial insurance coverage," he said, "to teach people how to be engaged in their health insurance plan."

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. 

Louisa United Methodist Church

Our neighbors are in need and we need your help to help them! Beginning today and going through Sunday evening we'll be collecting cleaning supplies for our friends in West Virginia who were affected by the recent floods. If you're coming to our Bible school this week or if you just want to make a donation please drop them off at our Church door and we'll take care of it. Here is a list of items needed at this time:

Brooms
Mops
Bleach
Trash bags
Gloves
Bottled water
Peanut butter and other non-perishable food items that do not require being heated up or cooked

PLEASE SHARE

 

“People are using the morning after as a form of birth control, especially among college students,” Johnson said.Across the state, the number of teens giving birth improved according to the Kids Count Data Book — one of many bits of information about Kentucky that can be found.

In Boyle County, however the number hovered around the middle to upper 30s in rate per 1,000. While one of the lowest counties in the region, it is also one of the few that has continued to grow, even slightly.

The latest numbers for the data come from 2011-2013, which states that 37.4 teens per 1,000 in Boyle County were pregnant; 59.3 per thousand in Casey County, which is down from the previous three years; 42.1 per 1,000 in Garrard County, up slightly from the previous measure; 52.2 per 1,000 in Lincoln County, down from the previous measure; and 47.6 per 1,000 in Mercer County, up from the previous measure. Statewide, teen births have dropped to 35 per 1,000.

The data comes from the Kentucky Cabinet for Health and Family Services, Vital Statistics Branch, and is processed by the Kentucky State Data Center.

Not sure of the causes behind why the numbers locally hover around the same, Tiffany Johnson, the director of Haven Care Center, a pregnancy care center in Danville, said she could understand why the numbers might be dropping across the state.

Johnson believes the ease-of-access to the morning after pill could have a direct impact on the reduced numbers. No prescription is needed to pick up the medicine, which can be obtained at Walmart and other stores.

“People are using the morning after as a form of birth control, especially among college students,” Johnson said.

JUNE 26, 2016

There's a vaccine for young people that prevents cancer, but most of them don't get it because most doctors fail to recommend it

By Melissa Patrick
Kentucky Health News

The human papilloma virus vaccination is proven to prevent cervical cancer and genital warts, but many pediatricians and family doctors still don't strongly recommend it, and they need to do better.

That was the main message at an HPV conference in Lexington June 21, where more than 100 people, mostly health-care providers, came to learn about the cancer-causing virus and the under-utilized vaccine that prevents it.

Dr. Alix Casler, medical director of pediatrics at Orlando Health Physician Associates in Florida, stressed the importance of teaching everyone in a health-care organization about why HPV vaccinations are so important.

"Every year that we fail to reach our goal, there are thousands of children who are going to go on to develop cancer," Casler said. "It is one of the most lifesaving things we do," but because it isn't mandatory and the diseases that it causes aren't ones pediatricians deal with, it often falls to the bottom of providers' priorities, she said.

Studies show that a "clear recommendation" from a physician is the most important factor in whether children get the HPV vaccine. Casler noted that a 2013 survey found that 80 percent of mothers who received a same-day recommendation had their son or daughter vaccinated that day.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

HPV is spreading. About 79 million people in the United States are infected with it, and about 14 million more become infected each year. It is estimated that half of these new infections occur in people 15 to 24 years old.

Though most HPV infections will clear up on their own, the most persistent strains of the virus are directly linked to 27,000 new cancers a year. About 30 women per day in the U.S. are diagnosed with cervical cancer caused by HPV, and every year, there are about 324,000 new cases of genital warts caused by the virus.

Lois Ramondetta, a gynecologic oncologist at MD Anderson Cancer Center in Houston, who is on a mission to educate health-care providers about the vaccine, told clinicians in southern Texas, “If you are not recommending the vaccine, you are not doing your job. It’s the equivalent of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.” So reports Laurie McGinley for The Washington Post.

HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact, including genital contact of any kind or simply kissing.

Doctors and parents alike have struggled with the idea of giving young children a vaccine for a sexually transmitted disease. And some parents hesitate because they say the vaccine encourages sexual promiscuity, though research says otherwise.

Caslir said that just like putting on a seat belt to protect yourself before you turn on the engine, the most effective time to vaccinate for the cancer causing HPV virus is prior to exposure. In addition, it is important to vaccinate pre-teens early because they have the best immune response to the vaccine and are more likely to keep coming in for annual visits.

Dr. Daron G. Ferris, a speaker at the conference who works at the Georgia Cancer Center in Augusta, said that a mother of a 21-year-old woman with cervical cancer caused by HPV asked him, "So you mean if my daughter had received the Gardasil shots, she probably would not be having this surgery today?" and that he told her, "Yes. She would not have been there if she had been vaccinated."

Kirk Forbes, whose daughter Kristen died at the age of 23 from cervical cancer caused by a high risk strain of HPV, told the story of his daughter's battle. He and his wife have founded the Kristen Forbes EVE Foundation, whose mission is to eradicate cervical cancer and significantly reduce HPV infection rates. One of the foundation's efforts is a nationally acclaimed documentary that profiles five women, including Kristen, called "Someone You Love: The HPV Epidemic."

"We have the means to stop 90 percent of cervical cancers and who know how many versions of oral cancer, anal cancer, penile cancer... and could literally wipe out genital warts," Forbes said."We've got all the tools we need, now we've got to go out and get the job done."

Posted by Melissa Patrick at 9:08 PM

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.

 

Date: 06-23-2016

Public Health, Fish & Wildlife, park officials work together to prevent Zika

FRANKFORT – The Kentucky Department for Public Health is working with Kentucky Fish & Wildlife and State Parks to inform residents about the risks of exposure to the Zika virus through mosquito bites and how to stay safe in the outdoors throughout the summer.

“It is important that everyone act to protect yourself and your loved ones this summer from mosquito bites and potential illnesses that mosquitos may carry,” Dr. Ardis Hoven, Infectious Disease specialist for the Kentucky Department for Public Health, said in a state news release. “With the summer season upon us and residents spending more time exploring the great outdoors in Kentucky, we want people to be aware of Zika virus and we want to advise residents to follow these recommendations in order to prevent mosquito bites while outside.”

· Wear long sleeved shirts and long pants. In warmer weather wear lightweight, loose-fitting clothing that covers exposed skin. Wear socks that cover the ankles and lower legs.

· Use Environmental Protection Agency-registered insect repellents such as DEET, picaridin, oil of lemon eucalyptus, or IR3535. When used as directed these are safe and effective, even for pregnant and breast-feeding women. Always follow directions, and reapply as directed. Apply sunscreen prior to insect repellent if using both.

· Do not use insect repellents on babies under two months of age. Instead, dress your baby in clothing that covers the arms and legs, or cover crib, stroller, or carrier with mosquito netting.

· Treat clothing and gear with permethrin. Do not use permethrin directly on your skin.

“We encourage state park guests and anyone who will be outside this summer to take these precautions to prevent mosquito bites,” Donnie Holland, commissioner, Kentucky State Parks, said in the news release. “It’s a good idea to keep these steps in mind when you make plans to camp, hike or play outside.”

“We want families to enjoy Kentucky’s great outdoors this summer,” said Kentucky Fish and Wildlife Commissioner Gregory Johnson. “These simple, common sense precautions will help protect people against illnesses borne by both mosquitoes and ticks.”

DPH recently launched its “Fight the Bite Day and Night” campaign to provide information to the public about the Zika virus and ways to avoid being bitten by the mosquitoes that carry it. Currently, no Kentuckians have acquired the Zika virus infection through local transmission in Kentucky. Careful prevention is key to preventing a public health emergency in our Commonwealth! 

For further information regarding Aedes mosquitoes and the diseases that they may transmit, visit the DPH website http://healthalerts.ky.gov/zika or the Centers for Disease Control and Prevention website at www.cdc.gov/zika. Be sure to follow KYHealthAlerts on Twitter and DPH’s Zika mascot, Marty Mosquito, on Instagram, @martymosquito.