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JANUARY 4, 2016
January last ‘open enrollment’ month for the Health Insurance Marketplace
Avoid paying a penalty; Three Rivers Medical Center offering free application assistance
Consumers who have not yet signed up for health insurance through the government’s Health Insurance Marketplace still have time—but two important deadlines are fast approaching.
A plan must be selected and the premium paid by January 15 to obtain coverage by February 1; for coverage effective March 1, the plan and premium must be finalized by January 31.
Three Rivers continues to offer free application assistance to help individuals evaluate insurance options on the Marketplace and complete their application forms. However, the Medical Centercertified assistors are encouraging those needing help to reserve appointments early, as schedules typically book quickly this month. Call 606-638-7494 or visit www.threeriversmedicalcenter.com to make an appointment.
Increased penalties for 2016 are driving many newcomers to the Marketplace, as most individuals must choose between purchasing insurance and paying a fine. Fines are $695 per adult, $347.50 per child, and up to $2,085 per family or 2.5% of family income—whichever is higher. The fines will be assessed when 2016 federal tax returns are filed.
According to the U.S. Department of Health & Human Services (HHS), the great majority of consumers purchasing plans on the Marketplace are qualifying for financial assistance; this reduces their premium cost—which is the monthly fee charged for coverage. Most are expected to pay less than $75 per month.
All health plans on the Marketplace must offer a comprehensive set of benefits, and coverage cannot be denied for individuals with a pre-existing health condition. Some of the mandatory health benefits include free preventive care and wellness services, doctor visits, prescription drugs, hospital and emergency department care, lab services and pediatric services.
DECEMBER 30, 2015
By Al Cross
Kentucky Health News
FRANKFORT, Ky. – Gov. Matt Bevin said Wednesday that a University of Kentucky health executive and former state health secretary, Mark Birdwhistell, will help him design a Medicaid program that "will be a model to the nation." He said he hopes to know by the middle of 2016 whether his new administration can reach an agreement with federal officials on the shape of the program.
Beyond that, Bevin offered little new insight into his plans for Medicaid, which was a major issue in the race for governor. The Republican first said he would abolish Democratic Gov. Steve Beshear's expansion of eligibility for Medicaid under federal health reform, but after state Senate President Robert Stivers, R-Manchester, said the legislature would decide the future of Medicaid, and mentioned Indiana as a possible model to follow, Bevin started talking about modifying the program and using examples from other states including Indiana.
Birdwhistell is UK's vice president for health affairs and was health secretary under the last Republican governor, Ernie Fletcher. He and Bevin said they would work with various stakeholders, including health-care providers, to develop a plan in consultation with federal officials. Bevin said he had discussed the issue with federal Health and Human Services Secretary Sylvia Burwell, who has ultimate authority over the shape of state Medicaid programs because the federal government funds most of the program.
In talking about stakeholders, Bevin and Birdwhistell did not mention the General Assembly. Asked on his way out of a press conference what role the legislature would have in designing the program, Bevin said, "Obviously, until we have a plan, there's not much they can comment on."
Minutes later, Stivers went to Bevin's office for what appeared to be an unscheduled meeting, then emerged to say that the administration had been discussing Medicaid with him and other legislators, including Democrats, in the past few days. "He wants everybody to come to the table and have dialogue," Stivers said. "I told them that we could deal with it legislatively," he said, but noted that a 1966 law gives the governor the authority to restructure the program "without legislative approval."
Stivers said there is probably no better person to redesign Medicaid than Birdwhistell, and he said he was not concerned that whatever plan the UK official designs would help larger hospitals like UK's more than smaller hospitals.
Stivers said he hopes the program can include incentives for changes in health behavior, such as smoking, which is the leading cause of Kentucky's low health status. He said the managed-care companies that act like insurers for Medicaid patients are "managing dollars, not managing people." He concluded, "The ultimate goal is to make sure there is health care . . . that is sustainable and covers the same population."
Stivers's Eastern Kentucky district, and those of many other Republican senators, have large percentages of people on the Medicaid expansion, which made the program available to people in households with incomes up to 138 percent of the federal poverty level.
Bevin said in his campaign that the state would no longer be enrolling people in Medicaid at that level, but the health reform law makes extra federal dollars available only to states that enroll people up to that level. Federal officials have allowed no state waivers with any exemptions to the 138 percent rule. Asked if he was considering a request to reduce the eligibility level, Bevin said he did not plan to enroll people at 138 percent of poverty "under the existing reimbursement model."
Asked if currently eligible recipients might be required to have "skin in the game," a term Bevin has used to encompass premiums, co-payments and deductibles, he said, "Ultimately we want to take people from full dependency to a point where they can sustain themselves. . . . I think it's important for us to empower people, because with this comes dignity. We owe people the dignity and self-respect that comes with being able to make decisions for themselves even while they are dependent upon the assistance of others. This is what we will do."
The federal government pays the entire cost of the Medicaid expansion through 2016. States begin paying 5 percent in 2017, rising in annual steps to the law's limit of 10 percent in 2020. Kentucky is expected to need $257 million for its share in the two-year budget that begins July 1.
The Beshear administration, citing a state-funded Deloitte Consulting study, said the expansion would pay for itself through jobs and tax revenue generated by bringing more people into the health-care system, but Health Secretary Vickie Yates Glisson said in Bevin's press release that "Leading Kentucky economists agree that the health-care jobs predicted by the Deloitte study have not materialized, rendering the suggestion that Medicaid expansion pays for itself invalid."
Bevin said of the Beshear administration's claim, "That was a lie, a straight-up, straight-out lie." He added that traditional Medicaid, for which the state pays about 30 percent, will be $128 million over budget when the fiscal year ends June 30.
The governor said the share of Kentuckians on Medicaid is "fast approaching" 30 percent, and "That is literally not sustainable financially. The only way in which we are going to allow it to continue in any form – traditional, expanded or otherwise – is to transform the way in which it is delivered." The ultimate purpose, he said, is to help Medicaid recipients "have better health outcomes. That is the propose. That is the absolute intent behind everything that you're hearing today."
DECEMBER 23, 2015
Louisa, Kentucky - The Lawrence County Health Department will be offering the Freedom From Smoking® program, an 8-week smoking cessation class for adults. Meetings will be held on Thursday afternoons beginning January 21, 2016through March 3, 2016 from 3:00 p.m. until 4:30 p.m. at the Health Department Conference Room, 1080 Meadowbrook Lane, Louisa, KY.
As America’s gold standard smoking cessation program for over 25 years, Freedom From Smoking® helps participants create personalized plans to overcome their tobacco addiction.
Studies show that people who use the program are six times more likely to be smoke-free one year later than those who try to quit on their own.
According to Debbie Miller, Director of the Health Department, the program is especially helpful because (it’s taught by a trained facilitator who helps participants learn what triggers their smoking, when they’re most likely to smoke and the best way to approach the quitting process.
The public can enroll in the program by calling 606-638-4389 on Monday through Thursday from 9 a.m. until 4:30 p.m. and on Friday from 9 a.m. until 1:30 p.m.
DECEMBER 30, 2015
The deadline to get health insurance for 2016 and avoid a penalty for not being insured is Jan. 31 and this year, unlike last, there will be no extension, Baylee Pulliam notes for Louisville Business First.
More than 3,000 Kentuckians missed the initial deadline this year but then gained coverage because of the extension, Jill Midkiff, executive director for communications for the Kentucky Cabinet for Health and Family Services, told Pulliam. This extension was meant to help those who weren't aware of the penalty for not having health insurance util they started to file their income-tax returns and saw it.
"A special enrollment period around the April 15 tax filing deadline will not be offered this year," Kevin Counihan, CEO of HealthCare.gov, the federal government health insurance exchange, wrote on The CMS Blog. "If you don’t enroll by then, you could have to wait another year to get coverage and may have to pay the fee when you file your 2016 income taxes.”
The penalty for not having health coverage in 2015 is $325 per adult and $162.50 per child (up to $975 for a family), or 2 percent of their annual household income, whichever is higher.
The penalty for next year is $695 per adult and $347.50 for each child (up to $2,085 per family), or 2.5 percent of annual household income, whichever is higher.
If you're not sure what your penalty could be, there's a calculator tool on the HealthCare.gov website.
Counihan said that for many the fee is greater than the yearly cost of a plan and that generally, "the higher your income, the higher the fee you will have to pay."
So far, 60,277 Kentuckians have enrolled in subsidized 2016 coverage through Kentucky's exchange, Kynect, and about 30,000 haven't renewed their plans, Midkiff told Pulliam in early December.
For coverage that takes effect Jan. 1, the deadline is Dec. 15.
Posted by Melissa Patrick
Kentucky Health News is an independent news 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.
DECEMBER 21, 2015
In the end, lung cancer left Jerome Grant voiceless, a breathing tube in his windpipe.
He could say nothing when his wife Dawn spoke her last words to him: “I love you, you know that?”
He gave her a thumbs up. Then he closed his eyes and was gone.
The 52-year-old Louisville man was one of about 10,000 Kentuckians a year taken by cancer in a state where the disease consistently kills at the highest rate in the nation. Experts say the biggest culprit is lung cancer, which strikes and kills Kentuckians at rates 50 percent higher than the national average. But Kentucky’s death rates also rank in the Top 10 nationally for breast, colorectal and cervical cancers.
“It’s really been driven by three major things: obesity, smoking and lack of screening,” said Louisville gastroenterologist Dr. Whitney Jones. “Our state is completely inundated with risk factors.”
Smoking, a stubborn vestige of the state’s tobacco legacy, is at the root of most lung cancers, although other environmental causes such as radon play a part as well. Obesity, a risk factor for several cancers, also hits Kentucky hard, afflicting more than three in 10 residents. Poverty, lack of education and doctor shortages mean residents are less likely to get screenings that can find cancer early - or effective treatment.
Indeed, cancer preys upon the rural poor across the nation, and Kentucky is both rural and poor. Although it’s nationally known for giving half a million residents insurance through the Affordable Care Act, the law's rollout faces an uncertain future, since Gov.-elect Matt Bevin has pledged to scale back Kentucky’s Medicaid expansion and dismantle its online insurance-shopping site. And coverage is only one key to health care; it doesn’t automatically give people the other necessary keys, such as health “literacy,” doctors who will take them, time off from low-wage jobs or reliable transportation to appointments.
Despite attempts to curb deaths by the state and its health care system - and signs of hope such as increases in cancer screenings among Medicaid patients - Kentucky remains far behind other states in reducing the toll of this dreaded malady that touches nearly every family.
So too many continue to suffer the same sort of devastating loss Dawn Grant did when cancer left her a widow in her 50s. Every day she misses the “good, generous, kind person” who was stepfather of her two children, caregiver for his sick father and a motorcycle enthusiast who filled her life with adventure.
“I just thought we’d grow old together,” she said. “But all of a sudden, you’re on your own.”
Incidence per 100,000 people: 92.4, compared with 60.4 nationally. Mortality per 100,000: 68.8 - around 120 in the hardest-hit Appalachian counties - compared with 45 nationally.
Thomas Tucker, director of the Kentucky Cancer Registry, said lung cancer is by far the biggest reason for the state's continual struggle with cancer mortality. “The problem with lung cancer," he said, "is we’ve always found it late.”
One reason is that most lung cancers don’t cause symptoms, so people don't know they're sick until the disease has spread so far they can’t be cured. Until recently, there’s been no screening test, and today’s preventive low-dose CT scans for longtime smokers are far less routine than tests like mammograms or colonoscopies and are not always covered by private insurance.
Jerome Grant, an asphalt worker, had a cough for about a year, but his wife thought it was just sinus drainage. He also seemed a little run down, but he was working six days a week and caring for his dying father at the time. Still, Dawn Grant, who works as an administrative assistant at KentuckyOne Health’s James Graham Brown Cancer Center, eventually began to suspect bronchitis or walking pneumonia, and insisted Jerome go to an immediate care center.
There, he got a chest X-ray in May 2011. Follow-up scans showed cancer in his right lung and metastases in his brain.
After two weeks of radiation and one chemotherapy treatment, he was hospitalized twice in rapid succession. But nothing could save him. He died in early July.
“It all happened in six weeks. It was like a whirlwind,” she said. “He went down so fast.”
Like many lung cancer victims, Jerome was a longtime smoker. Kentucky’s smoking rate is consistently first or second in the nation, with the habit most common among low-income Kentuckians and rural residents in tobacco country.
“For many years, Kentucky has had a quarter of adults smoking,” said oncologist Dr. Goetz Kloecker, a lung cancer specialist with University of Louisville Physicians. “I have patients who started puffing at 8, 9 and 10 years old…It’s part of the culture.”
Because of that culture, “cigarettes are still cheaper than in other places,” Kloecker added. “If you go to Chicago or New York, there are fewer teenagers starting to smoke. The higher the costs, the lower the smoking rate.”
A growing body of research shows smoking may not be acting alone in some cases. The risk of lung cancer is much higher for smokers exposed to carcinogens such as radon, asbestos, arsenic or chromium.
The U.S. Environmental Protection Agency classifies a wide swath of Central Kentucky as having the highest potential for indoor radon gas, the second-leading cause of lung cancer. And research by Tucker and others has shown high rates of arsenic and chromium in Appalachian residents.
Environmental carcinogens can also contribute to lung cancer in non-smokers. Nationally, up to 20 percent of those who succumb to lung cancer are non-smokers, although this includes people exposed to secondhand smoke as well as environmental carcinogens.
On top of all this, lung cancer remains difficult to cure despite new surgical techniques and other medical advances. The five-year survival rate is less than 20 percent overall.
At the most advanced stage, it’s less than one percent.
When doctors found Kenneth Kummer’s cancer, they didn’t even know where it started because it had spread so far in his body, with tumors in his colon, stomach, gall bladder, liver and pancreas. A biopsy showed the disease originated as colorectal cancer, for which he had never been screened. He had two risk factors for the disease: He was a longtime smoker who was overweight for much of his adult life.
Doctors started chemotherapy in March 2014. Kummer’s daughter Shannon McCowan recalled how her son A.J., who called him “pawpaw” and was “the light of his life,” gave him a Buzz Lightyear doll and said: “Buzz will give you the power to overcome this.” Kummer brought it to every doctor’s appointment and chemotherapy session, snapping pictures for A.J.
But despite the doctors’ best efforts, the cancer decimated Kummer’s body, causing him to wither from 235 pounds to 110. He died April 12 at age 62.
Sylvia said he was a kind spirit and the love of her life, helping raise their daughters and several foster children, serving as a volunteer firefighter and playing Santa Claus for the family during the holidays. They started out as high school sweethearts and were married for 42 years.
Since his death, she’s nearly been overcome when she’s found his flannel shirts and jeans lying around, or when she recently spotted the beginnings of a dollhouse he wanted to build for her. The base and the chimney were all he had time to finish.
Kummer's family will never know if a screening could have saved him, and many other Kentuckians are taking similar chances by not getting recommended colonoscopies, Pap smears to check for cervical cancer or mammograms to detect breast cancer. Pap smears and colonoscopies can even find pre-cancerous changes, which can be treated before they turn into cancer.
For cervical and colorectal cancer, “the single most important thing is the screening,” Tucker said. “Screening, we believe, is also very effective” in breast cancer. “But there is overwhelming evidence we are under-screening.”
For example, federal figures analyzed by the American Cancer Society show 46.8 percent of Kentucky women 40 and older got a mammogram and clinical breast exam in the past year, compared with around 60 percent in states with the best rates; and 81.6 percent of Kentucky women 21-65 years old got Pap smears in the past three years, compared with around 90 percent in states with the best rates.
Experts say many Kentuckians don’t know the screening recommendations and have low health literacy overall, which goes hand in hand with poverty and low education levels. One in five Kentuckians lives below poverty, the fifth-highest rate in the nation, and 21 percent of adults over 25 have at least a bachelor’s degree, compared with 29 percent nationally.
Shortages of doctors and cancer screening and treatment facilities make things even worse. A workforce capacity study conducted for the state by Deloitte Consulting in 2013 found that Kentucky needed 3,790 more doctors just to meet pre-ACA demand and would need many more by 2017.
Complicating matters, rural Kentuckians often live long distances from specialists and cancer centers, and may face transportation problems as well. Tucker cited research showing the longer the drive to medical facilities, the later cancer is diagnosed.
Sometimes, people just don’t know the importance of screening, or, in the case of colonoscopies in particular, simply don’t like the idea of the procedure. Vernon Hyberger of Louisville, who had colon cancer in his family, just didn’t like getting colonoscopies and had no sign of a problem, said his daughter, Chris Thompson. So he didn’t get the screening that could have caught the cancer that killed him in 2011 at age 84.
Thompson said cancer stole the patriarch of a clan neighbors used to call “the ‘Leave it to Beaver’ family.”
“He was just one of a kind,” a German Catholic gentleman who devoted himself to God and family, she said. “The best father in the world.”
Just over half of all cancer deaths in Kentucky are from lung, breast, colorectal and cervical cancers - diseases that Tucker said people and governments can do something to prevent. So he suggests “we focus on the ones we can impact.”
Doctors are optimistic about signs of progress, particularly in colorectal cancer. The Colon Cancer Prevention Project, founded by Jones, has raised money and awareness of the disease across the state and pushed for programs such as free screening for low-income, uninsured residents. Since the group started 11 years ago, the screening rate has more than doubled to 69.6 percent, and colorectal cancer deaths are down more than 25 percent statewide.
Other organizations are trying to control all types of cancer, including the Kentucky Cancer Consortium, made up of more than 70 groups working on prevention, early detection and treatment; and the Kentucky Cancer Program, which aims to reduce incidence and mortality through education and research. Partners in the fight include hospital systems, doctor groups and state health officials.
Stephanie Mayfield Gibson, commissioner of the Kentucky Department for Public Health, said the ACA has started to make a difference, with screening levels rising among Medicaid recipients since the law took effect. Recent state data shows those receiving breast cancer screenings rose 111 percent from 2013 to 2014; those receiving cervical cancer screenings rose 88 percent, and those receiving colorectal cancer screenings rose 108 percent.
“Getting insurance is one huge step toward improving overall health,” Mayfield Gibson said.
She said the state is committed to strive toward better health in all its policies, and cited a recent smoking ban on certain state property, and an initiative launched in 2014 called kyhealthnow, which aims to reduce deaths from chronic diseases such as cancer. Despite such efforts, however, the health department devoted only 2.3 percent of its $380 Fiscal Year 2015 budget to cancer specifically - $3.6 million in direct spending and about $5.2 million in indirect spending for programs like radon and smoking cessation.
Doctors say making significant strides against the disease will take an unwavering commitment and bold action from the state, the medical establishment, advocacy groups and residents. Snuffing out smoking will require higher cigarette taxes and more spending on tobacco control, they say, and obesity will be a huge challenge given the poor diets and sedentary lifestyles of many Kentuckians.
But any gains against the disease come too late for thousands of Kentucky families - like Kummer’s.
Since his grandfather died of colon cancer, A.J. sometimes curls up in Kummer’s old favorite chair, where they used to cuddle together to watch television.
“He knows his grandpa is an angel,” McCowan said. “He still has his moments, though.”
The boy also has mementos, such as one of two matching, white stuffed ponies he and Kummer once shared.
The other is in his pawpaw’s casket.
By Laura Ungar