Business leaders discuss possibility of expanding Medicaid through private insurance

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."

Baucus sees a health-reform 'train wreck,' fearing insurance exchanges won't be ready

Max Baucus (J. Scott Applewhite, AP)

Senator Max Baucus, who as Senate Finance Committee chair helped write the health-care reform law, has become the highest-ranking Democrat to publicly voice concerns about its implementation, saying he thinks it’s headed for a collision with itself.

“I just see a huge train wreck coming down,” the Montanan told Health and Human Services Secretary Kathleen Sebelius during a budget hearing.

Matt Gouras of The Associated Press notes that polls show that Americans are confused by the complex law, which is designed to cover about 30 million uninsured people through a mix of government programs and tax credits. Baucus told Sibelius he’s “very concerned” that new health insurance exchanges will not open on time in every state and residents will not have enough information to make choices even if they do open on time, as Kentucky's seems likely to do.

"The administration’s public-information campaign on the benefits of the Affordable Care Act deserves a failing grade,” Baucus lectured. “You need to fix this.” Baucus’ office later told Gouras that the senator still thinks the Affordable Care Act is a good law, but questions its roll-out.

Sebelius said that the administration is on track to fully implement exchanges in January, and to be open for open enrollment on Oct. 1, 2013, reports Gouras. Kentucky is among the states that have chosen to build a fully state-based exchange. Others have chosen a state-federal partnership exchange, or defaulted into a federally facilitated exchange. The map below shows the lay of the land about that decision. Yellow states have defaulted to a federal exchange, light blue states are planning for a partnership and blue states have chosen a state-based exchange.

Map provided by the Kaiser Family Foundation

FDA requires OxyContin pills to be non-crushable to deter abuse

The Food and Drug Administration announced Tuesday that it would block generic, crushable versions of OxyContin from coming to the market and approve the reformulated, non-crushable OxyContin, which deters abuse of the powerful painkiller.

U.S. Senate Republican Leader Mitch McConnell applauded the move. “Given the public health epidemic of prescription drug abuse and the ravaging effects it has on families all across Kentucky, this announcement is great news and will prevent an influx of crushable, generic OxyContin from coming to market,” McConnell said in a release.
 
OxyContin is a potent drug designed to treat severe pain. Without abuse-deterrent formulas, addicts can crush the pills to get an immediate heroin-like high. The reformulated product has properties that make the tablet harder to crush, break, or dissolve and that prevent it from being injected in order to achieve a quick high, an FDA press release said.

Drug overdoses are now the leading cause of death in Kentucky, and law enforcement, lawmakers and health providers have expressed their concerns that crushable, generic versions would worsen the problem.

The FDA decision came on the same day manufacturer Purdue Pharma’s patent on the original drug was set to expire, and McConnell has been actively meeting with federal officials on behalf of those concerned. Rep. Hal Rogers, R-5th, also lobbied for it. (Read more)

In an editorial, the Lexington Herald-Leader points out that the move means a continued OxyContin monopoly and more profits for Purdue Pharma, which "paid $600 million in fines in 2007, and three of the company's executives paid a total of $34.5 million, after they pleaded guilty to misleading doctors and the public about OxyContin's addictiveness. . . . We wonder why Rogers and McConnell aren't calling for Purdue to voluntarily share its new formulation."

Lawsuit alleges state health insurance exchange is unauthorized

Tea Party activist David Adams filed a lawsuit Monday challenging Gov. Steve Beshear's legal authority to create Kentucky's health insurance exchange without approval from the General Assembly. The governor created the exchange by executive order to offer health insurance plans for Kentuckians under federal health reform, but did not ask the legislature to approve it.

Adams claims state law requires the exchange to get legislative approval, and he seeks an injunction against it. The law allows the governor to temporarily reorganize units of state government and calls for them to be approved by the General Assembly.

Beshear's office says he exercised his constitutional authority to meet the requirements of federal law, reports Jack Brammer of the Lexington Herald-Leader.

Adams said in a telephone interview, "There is nothing in the constitution that allows him to set up a new bureaucracy that taxes, gains fees or spends money without legislative approval." He added, "This isn't about politics. It is simply about gubernatorial authority in the absence of legislative approval."

Kentucky has received about $250 million from the federal government to cover the initial costs of exchange, but Adams said that is being spent rather quickly and funds will be exhausted by 2014, he said. The state will be responsible for all funding for the exchange beginning in 2015; it plans to fund it with fees from participating insurance companies.

Kentucky is one of 17 states that the federal government approved to build its own exchange, which will be operated by the Cabinet for Health and Family Services and is expected to help insure more than 600,000 Kentuckians. (Read more)

Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program

By Molly Burchett and Al Cross
Kentucky Health News

If Kentucky expands its Medicaid program, it will probably be able to reduce the cost by requiring patients whose incomes are above the federal poverty level to help pay for their care. That could make it more feasible for the state to expand the program to people with incomes up to 138 percent of the poverty line.

A proposed federal policy will let states charge co-payments and increased premiums for doctor visits and some prescription drugs and hospital care. Robert Pear of The New York Times reports that the policy is designed to encourage states to expand Medicaid under the federal health-care reform law, with generous federal help. By shifting costs to patients, the state and federal governments would pay less.

That adds a new perspective to the cost consideration in Kentucky's debate over expansion of Medicaid. It could influence the state's decision, Republican state Sen. Julie Denton of Louisville said Friday during a legislative panel at the Kentucky Press Association convention.

Denton cautioned that the state needs to fix its problems with Medicaid managed care before it expands the program. Democratic Gov. Steve Beshear has said he wants to expand Medicaid if the state can afford it, and since there is no deadline for deciding whether to participate in the expansion, the debate may carry over into 2014.

Some Republicans have said Kentucky can't afford the expansion. If the state expands Medicaid eligibility to 138 percent of poverty from its current threshold of 70 percent, the federal government would pay all the cost of the expansion until 2017, when the state would begin helping out, with its share reaching 10 percent in 2020. The federal share of the state's current program is 72 percent.

This proposed rule could have important implications not just for state finances, but for Medicaid patients. It means that a family of three with an annual income of $30,000 could be required to pay $1,500 in premiums and co-payments, Pear reports in the Times.

As published in the Federal Register last week, the rule proposes to "update and simplify Medicaid premium and cost sharing requirements, to promote the most effective use of services and to assist states in identifying cost-sharing flexibilities." It proposes "new options for states to establish higher cost sharing for nonpreferred drugs and to propose higher cost sharing for non-emergency use" of emergency rooms.

Barbara K. Tomar, director of federal affairs at the American College of Emergency Physicians, told Pear that the administration had not adequately defined the “nonemergency services” for which the poor might have to pay. "In many cases, she said, patients legitimately believe they need emergency care, but the final diagnosis does not bear that out," Pear writes.

The proposed rule has no limit on emergency department charges for "non-emergency use." It says the hospital will have responsibility to assess the individual clinically and ensure access to other sources of care before requiring payment, which could pose problems for hospitals.

The public has until Feb. 13 to comment on the proposed rule, which can be submitted at www.regulations.gov.

New tool allows analysis of nursing-home deficiencies across the country; Kentucky seems to rank high in serious problems

Reporters now have a tool at their fingertips that will allow them to find nursing home problems in facilities across Kentucky, which appears to ranks high in serious problems.(iStock photo)

The tool was launched this week by ProPublica, a nonprofit, investigative news group, and allows "anyone to easily search and analyze the details of recent nursing home inspections, most completed since January 2011," report Charles Ornstein and Lena Groeger.

The tool has features that the federal government's Nursing Home Compare doesn't have, including the ability to search using any keyword. Results can also be sorted according to the severity of the violation and by state.

About 1.5 million people still live in nursing homes nationwide, though more seniors are living at home or in assisted-living facilities. The reports show there were almost 118,000 deficiencies cited against 14,565 homes. According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven.

ProPublica's analysis shows Kentucky ranked fourth nationwide for the most "K" and "L" deficiencies, considered the most serious kind. The state had 45 in the analysis, as did South Carolina. Texas had the most in the country by far, however, with 183. 

While ProPublica does rank the states, nursing home industry officials say "inspectors in different regions of the country have different thresholds for issuing a citation, and that could unfairly make one state's homes appear worse than another's," Ornstein and Groeger report. (Read more)

About 290,000 more Kentuckians would be eligible for Medicaid if state expands program, Urban Institute study finds

About 289,000 more people in Kentucky would be able to get health insurance if the state opts to expand its Medicaid program up to 138 percent of the federal poverty level, as authorized by federal health-care reform, a new report from the Urban Institute has found. Just how many more Kentuckians would be affected by the possible expansion had previously been uncertain, with varying estimates.

Of those eligible, 56,000 are parents and 232,000 are adults who don't have dependent children, the report found. Those who are between the ages of 35 and 54 have the most to gain in the state, with 78,000 newly eligible Kentuckians falling into that age bracket. The report, funded by the Robert Wood Johnson Foundation, says about 15 million more people nationwide could get health insurance under Medicaid expansion.

Gov. Steve Beshear has said he will expend the program if the state can afford it, and is studying how much it would cost. The federal government will pay all the costs for the new eligibles at the through 2016, but by 2020, states will be responsible for 10 percent of those costs. For current eligibles, the state pays and would continue to pay about 30 percent.

Though much of the discussion on expansion is based on whether states can afford it, "Exclusively monetary calculations ignore the potential human, financial and productivity benefits associated with improved access to affordable health care for the millions of low-income adults who lack health insurance coverage and their families," the study's authors conclude. (Read more)

Legislators, doctors debate how health law will or should affect Kentucky; we answer some questions that were left hanging

By Tara Kaprowy and Al Cross
Kentucky Health News

Though host Bill Goodman (above, in an advance promo) said they just "scratched the surface" on what the federal health-care reform law will mean for Kentucky, physicians and legislators debated Medicaid expansion, the implications of requiring people to buy health insurance, how to pay for it all and other questions last night on KET's "Kentucky Tonight" panel and call-in show.

Perhaps the biggest question about the law in Kentucky is whether the state will choose to expand Medicaid, allowing as many as 329,000 more people with incomes up to 138 percent of the federal poverty threshold to qualify for the program for the poor and disabled and be paid for entirely by the federal government in 2014-16. State Rep. Mary Lou Marzian, D-Louisville, pushed hard for the expansion, saying "We can't leave 100 percent of the money laying on the table."

Starting in 2017, the amount of federal contribution will start to decrease — to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and subsequent years, according to the Henry J. Kaiser Foundation.

Kentucky already has a $400 million shortfall in its budget, said Republican state Sen. Tom Buford of Nicholasville, and would need "$515 to $695 million by 2020" to pay for the additional recipients. Other Republicans have said that would require higher taxes or cuts in services, and called for Gov. Steve Beshear to reject the expansion, but supporters of the law argue that the state will save money overall. For that story, click here.

Louisville urologist Michael Macfarlane, a member of the state Republican executive committee, said he would like to see everyone get health care, but "It really boils down to how are we are going pay for this. . . . In every program like this they underestimate what the future entails. . . . The money is not out there. . . . We are going to be Greece and Spain before long."

Marzian replied, "We are paying now for our uninsured folks that we can put onto Medicaid." Noting that the state has spent hundreds of millions of dollars to help the Kentucky Speedway and the Kentucky Horse Park and build the Yum! Center in Louisville, she asked, "Why can’t we help our middle class and the poorest of the poor get health insurance and health care?" She said the law will stimulate the economy because having more people insured will generate more need for health-care services and health-care jobs.

The panel also debated the implications of the law's requirement to buy health insurance or pay a penalty, which the U.S. Supreme Court upheld as a legitimate use of the taxing power of Congress. Marzian said requiring people to buy health insurance is "personal responsibility" since "everybody uses health care at some point."

Buford, an insurance agent and the chairman of the Senate Banking and Insurance Committee, contended that instead of buying health insurance, those not eligible for Medicaid could just choose to pay the penalty ($695 for individuals or up to 2.5 percent of the household income, the Kaiser Foundation notes) and when hospital care is needed, "She can buy insurance on her way in the ambulance," and after being treated, can cancel the policy.

"That is simply not true," Marzian said. "There is a waiting period." Well, not exactly.

Nicole Huberfeld, a University of Kentucky law professor whom Supreme Court Justice Ruth Bader Ginsburg cited in her opinion, told Kentucky Health News, "The law allows for one three-month grace period of non-coverage per year, so if a person were uncovered, then covered, then uncovered, then covered, penalties would be assessed for the second two non-covered periods." She called that scenario "economically inefficient" since "Most people do not choose to pay something, the tax penalty, for nothing: opting not to have insurance coverage."

In his blog for MoneyTalks News, Stacy Johnson argued that buying health coverage only when it's needed might also backfire: "If you go to the emergency room for a broken leg, will you sit there in agony, applying for insurance and waiting as long as it takes for newly purchased insurance to kick in?"

The liveliest debate on the hour-long show was between the two doctors, Macfarlane and Morehead internist Ewell Scott.

Macfarlane said, "This system really has nothing to do with helping people get health insurance, this system is really going to take over health care . . . directly by computer programs and protocols out of Washington," which he said will ration care and socialize the system. He said a new coding system that will require physicians to select from a vast number of codes — up to 68,000 in the new system from 13,000 in the old one, the American Medical Association indicates — to describe in detail the diagnosis and treatment of each case.

Scott replied, "I think Dr. Macfarlane, with all due respect, is crazy. . . . This is not going to happen." Asked is and how Macfarlane was misstating the facts, Scott said, "This is not going to be a problem for the physician." Macfarlane replied, "That's just not true."

The system in question is the International Classification of Diseases. The ninth version of the system has been in place for 30 years. The transition to ICD-10 will be effective Oct. 1, 2013, according to the Cabinet for Health and Family Services. Despite the increased number of codes, it is not expected to be more time-consuming for providers because "each diagnosis or procedure gets only one code," said Don McLeod, spokesman for the federal Centers for Medicare & Medicaid Services.

Scott acknowledged the law is not perfect and "does nothing to control costs in the long run," but called it "a baby step forward for getting us out of this terrible, dysfunctional health-care financing system we've gotten ourselves into." Scott noted the U.S. has the most expensive health-care system in the world "by double" but has "the worst outcomes in the world." A study by The Commonwealth Fund ranked the U.S. sixth of the seven main industrialized countries in terms of quality.

Macfarlane maintained, "We have the best system in the world." He acknowledged changes are needed, but "The idea that the mandate will pay for this is just false." Large swaths of the population, including young adults, undocumented immigrants and people who are out of work, will continue to avoid buying health insurance, he said. (In fact, undocumented immigrants are exempt from paying the penalty, according to the Kaiser Foundation.)

Goodman ended the show by acknowledging the subject's complexity and the need for more discussion on another episode later this summer or in early fall. To view the show, click here.

Kentucky Health News is a 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.

Expanding Medicaid will save the state money by eliminating much expense on the uninsured, think tank and op-ed writer argue

If Kentucky chooses to expand Medicaid eligibility up to 133 percent of the federal poverty level, the state will gain in key areas, argues Jason Bailey, director of the Kentucky Center for Economic Policy, right, in an op-ed piece in the Lexington Herald-Leader.

Citing numbers from the Urban Institute, Bailey said the law will provide more than 400,000 Kentuckians with health insurance whether through the expansion of Medicaid or through the state insurance exchange, a number he told Kentucky Health News is a "conservative estimate."

But the kicker is the move will also "result in deep savings in money now spent on the uninsured," he writes. Bailey again quotes from the Urban Institute report, which indicates the state will save between $140 million and $828 million in the first six years of the law in large part because of the decreased use of emergency rooms and because Medicaid will pick up most of the tab for mental health services, which states and local governments mostly shoulder alone.

The Center on Budget and Policy Priorities, though, estimates that states' Medicaid spending will rise by 2.2 percent by 2022 if they decide to expand Medicaid. But that number "actually overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in health-care costs for the uninsured," CBPP spokesperson Shannon Spillane told Suzy Khimm for The Washington Post. "In fact, states could end up with a net gain." (Read more)

Who is on Medicaid already? Not all poor Kentuckians, foundation president says on op-ed distributed to Kentucky newspapers

By Susan Zepeda
President and CEO, Foundation for a Healthy Kentucky

In the wake of the recent Supreme Court decision upholding much of the Affordable Care Act, states have many factors to weigh. Importantly, SCOTUS affirmed the right of states to opt out of the expansion in Medicaid coverage envisioned under Affordable Care, without penalty. Some state and national leaders have been heard to say that the poor are “already covered under Medicaid.”

Currently, nearly 15 percent of Kentuckians lack health insurance, including approximately 290,000 low-income adults who are uninsured and would be eligible for the Medicaid expansion. It may surprise many to know that about eight out of 10 uninsured Kentuckians are working adults. According to the Kaiser Family Foundation, Kentucky could benefit the most, compared to other states, as a result of the Medicaid expansion — with about 57 percent of our uninsured adults newly eligible for coverage.

While many believe that Medicaid provides coverage for all low-income individuals, Medicaid coverage is actually quite complex, with significant state-to-state variation. In Kentucky:
• Working parents are eligible for Medicaid only if they earn 62 percent or less of the federal poverty level - less than $8,926 per year for a family of two.
• Jobless parents are eligible if their total income is 36 percent or less of the federal poverty level – less than $5,144 per year for a family of two.
• Pregnant women are eligible if their income is up to 185 percent of the poverty level (about $20,665) but lose this eligibility, dropping to the lower income limits above, after the child is born.
• Legal immigrants, child or adult, in the U.S. for less than five years, are not eligible for Medicaid. Undocumented immigrants are not eligible for Medicaid coverage regardless of how long they’ve been in the U.S.

Susan Zepeda

In short, not all Kentuckians living in poverty are covered by Medicaid. If Kentucky does not take the option of expanding Medicaid, many individuals and families living in low-income and poor households will be left without health-insurance access.

The new law also creates health insurance exchanges, and places limits on out-of-pocket expenses on health insurance depending on income level. While these subsidies will allow many low-income parents and individuals to purchase health insurance, they appear only to be available for families above the poverty level.

And other pieces of the law were developed with the assumption that all states would expand Medicaid coverage. Because of this assumption, cuts to other federal health funding are built into the continuing roll-out of the Affordable Care law: For example, nationally Disproportionate Share Hospital (DSH) funding has provided an average of 95 percent of uncompensated care costs for state-owned hospitals; 69 percent of uncompensated care for local public hospitals; and 38 percent of uncompensated care for private hospitals. The law will reduce DSH funding by $14 billion over 10 years, starting in 2014.

This funding decrease to key providers was supposed to be offset by the increase in Medicaid coverage, since the number of uninsured individuals seen at hospitals would drop significantly under the Medicaid expansion. If Kentucky opts out of the Medicaid expansion, however, state, local, and private hospitals could be faced with sharp increases in uncompensated care (care provided but not paid).

The coming months will present opportunities for our state leaders to look at the sometimes difficult health realities of our Commonwealth and make decisions that will best serve the health of all Kentuckians. To quote the late Daniel Patrick Moynihan, “Everyone is entitled to his own opinion, but not to his own facts.”

Susan G. Zepeda is president and CEO of the Foundation for a Healthy Kentucky, a non-profit, non-partisan philanthropic organization that invests in communities and informs health policy through research, education and grant making.

FDA approves fast, take-home test that detects HIV

A model demonstrates how to use the OraQuick test, which
detects the presence of HIV in saliva.
AP photo by Chuck Zovko.

Soon, taking an HIV test will be no more complicated than swabbing one's mouth and waiting for the results. The Federal Food and Drug Administration last week approved the OraQuick test, which detects HIV antibodies and gives a result in 20 to 40 minutes. 

Orasure plans to start selling the test in October at local pharmacies and online, reports Matthew Perrone for The Associated Press. It is expected to cost less than $60 but more than the one used by health professionals, which costs $17.50.

About 240,000 of the 1.2 million people who are suspected of carrying the HIV virus don't know they are infected. 

The FDA says the test is not 100 percent accurate, but a trial conducted by Orasure showed it only detected HIV in people who have the virus 92 percent of the time. It was 99.9 accurate ruling out HIV in people not carrying the virus. People who test negative should re-test after three months because it can take time for the HIV antibodies to appear. (Read more)

Experts disagree on whether states will choose to expand Medicaid

Experts disagree on whether states will choose to expand Medicaid, a crucial, but voluntary, part of the federal health-care reform law. Yesterday, the Supreme Court ruled the federal government could not force states to expand the system for the poor and disabled, but that the expansion itself is constitutional.

Yesterday, both Gov. Steve Beshear and Senate President David Williams both indicated they are researching how Kentucky should proceed.

U.S. Sen. Lamar Alexander, R-Tenn., said "many states, maybe most, will decide that they simply cannot afford to choose to expand Medicaid." Though the federal government will pay for the newly eligible enrollees for several years after the law takes effect in 2014, states will eventually have to pay 10 percent of the cost.

Despite the expected cost, Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that "only a small number of states" will pass up the opportunity to expand, given the federal government's generous offer, reports Robert Pear for The New York Times.

The Medicaid expansion is central to the health care law, since about 17 million of the 30 million Americans who will newly qualify for health insurance will do so under Medicaid. In Kentucky, that translates to 280,000 more people enrolling in the program.

Senior administration officials said they feel sure states will choose to expand Medicaid, but Republican governors like Mitch Daniels in Indiana and Bob McDonnell in Virginia would not commit either way. Daniels said the expansion would cost Indiana $2 billion in the next 10 years.

And though U.S. Sen. Max Baucus, D-Mont., is one of the authors of the new law, he was not sure his own state would opt to expand. He did call the offer of federal assistance "a big juicy carrot." (Read more)

Expert: Health care landscape already changed, despite what Supreme Court decision is this week

Whether or not the federal health-care reform law is upheld by the U.S. Supreme Court tomorrow, initiatives are already in place that will change the way health care is delivered, an expert said at a Lexington conference Tuesday. Gregg Nunziata, senior director at research and consulting firm The Advisory Board in Washington, D.C., "said the burgeoning number of baby boomers entering retirement, the ever-accelerating advances in technology and the increasing public health crisis that finds more and more Americans with chronic illness such as diabetes, are fundamentally changing how health care works in America," reports Mary Meehan for the Lexington Herald-Leader. As people age, they are "demanding a different kind of care, and they will be living long into their golden years," he said. When they become seniors, who already tend to cast their vote, they will become a powerful voting bloc.

Health officials are looking at ways to cut down on costs, which is necessary because "the government is the major funding source, and the major funding source is broke," Nunziata said. To cut costs, the government and insurers are looking at new ways to pay for health care. One example is the Centers for Medicaid and Medicare scoring hospitals based on their performance and paying them accordingly. "A low score could reduce payments by only 1 percent or 2 percent," Meehan reports, but that can translate to a multi-million dollar loss. "Every hospital is being judged and Washington is keeping score," he said.
Bundling payments is another method being tried, in which one flat fee covers all of the care that is provided in a procedure. "The idea would be to force more efficient and cost-effective care by encouraging cooperation," Meehan reports. (Read more)

Bipartisan report from ex-secretaries of health and agriculture makes 26 recommendations for fighting obesity epidemic

Four former secretaries of heath and agriculture and the Bipartisan Policy Center have released a lengthy report aimed at the nation's obesity epidemic. With 26 recommendations, the report promotes public and private sectors working together to create healthy families, schools, workplaces and communities.

The report, called "Lots to Lose," recommends extending federal guidelines for diet and physical activity to all children under 6 years old, along with offering more support to promote breastfeeding. "Learning to be active and staying active is a critical piece of the puzzle," said Republican Mike Leavitt, former secretary of health and human services and former governor of Utah. "Government has a role to play, but it is not the answer."

"If you think this is fluffy stuff about diet and exercise or about creating a nanny state you are wrong," said Dan Glickman, who was a Democratic congressman from Kansas and agriculture secretary under Bill Clinton. "Americans like silver bullets to solve problems. This one requires silver buckshot."

Former agriculture secretary Ann Veneman, a Republican who served under George W. Bush, spoke of the importance of good nutrition during the first 1,000 days of a child's life. "Improving health outcomes early in life is a critical element in helping to shift our current health care system toward prevention," she said.

Democrat Donna Shalala, president of the University of Miami and health secretary under Clinton, also participated. While The Washington Post's Janice D'Arcy called the report "an earnest and comprehensive effort," she asked, "Haven't we been down this road before?" For the report, click here.

Poll finds parents overwhelmingly support more nutritious school food; USDA expected to issue new guidelines

Photo by Reuters' Lucy Nicholson

Chocolate bars, Cheetos and cheesy fries may soon be a thing of the past at public schools in America, and that's fine with parents, a new poll has found.

The survey found "most people agreed the chips, soda and candy bars students buy from vending machines or school stores in addition to breakfast and lunch are not nutritious, and they support a national standard for foods sold at schools," reports Susan Heavey for Reuters.

As it did for school lunch earlier this year, the U.S. Department of Agriculture is expected to release new guidelines for vending machines and à la carte sales by June, some experts say.

In Kentucky, schools are already not allowed to sell food that competes with the national school lunch and breakfast programs from the minute students arrive in the morning until 30 minutes after the last lunch period. Only water, 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving are allowed to be sold in school vending machines, as per state mandate. There are no limits as to what food or drinks that can be sold in fundraisers.

The poll, conducted by advocacy group Kids' Safe and Healthful Foods Project, found 80 percent of the 1,010 adults surveyed said they would support nutritional standards that limit the calories, fat and sodium in such schools.

Students eat one-fifth to one-half of their daily diet at schools, and the Centers for Disease Control and Prevention report 20 percent of American children are obese, As of 2007 in Kentucky, more than 37 percent of children were either obese or overweight, a study by the National Conference of State Legislatures shows.

A study by the National Academy of Sciences reports that about $2.3 billion worth of snack food and drinks are sold each year in schools nationwide. As such, changes might be controversial. The new guidelines for school lunch met with resistance from lawmakers, who "locked limits to french fries and counted pizza as a vegetable because it contains tomato sauce," Heavey reports.  There are concerns industry lobbyists and members of Congress could dilute the USDA proposals. (Read more)

Rogers joins bill to link up states' prescription drug monitoring systems

Though a state bill aimed at quashing "pill mills" by proactively tracking drug prescriptions has so far failed to pass in the Kentucky General Assembly, Republican U.S. Rep. Hal Rogers of Eastern Kentucky's 5th District has joined a federal effort to allow state prescription drug tracking systems to share information. Though 48 states have such systems, there is no way for them to communicate with each other.

On Thursday, federal lawmakers introduced legislation "that would establish technical standards and security and encryption procedures to ease sharing information," James R. Carroll reports for The Courier-Journal.

"While my region of Southern and Eastern Kentucky became ground zero for the abuse of prescription drugs a decade ago, it is now wreaking havoc on communities small and large and cutting across socioeconomic and gender lines," Rogers said in a statement.

About 1,000 people in Kentucky died last year from prescription drug abuse, though the real number is suspected to be higher, due to under-reporting.

Missouri and New Hampshire are the only states that do not have, or don't have plans to set up, a drug-monitoring system that allows "doctors, pharmacists and law enforcement to share information that may identify abuse and misuse of pharmaceuticals," Carroll reports.

"It is high time we get these systems linked up to eliminate the interstate doctor-shopping which has been fueling the pill pipeline around our country," Rogers said.

The proposal would not create a new national database, but would also states to communicate with each other through data hubs already in place. The bill is expected to get the support of the White House administration, Carroll reports. (Read more)

Last week, Gov. Steve Beshear said Kentucky would sign an agreement to share and receive prescription drug dispensing data with at least 20 other states. "The blight of prescription drug abuse is tearing our families and communities apart, and we must use every tool available to attack this deadly scourge on our state," he said. "One of our key strategies is sharing information with surrounding states, so that we can not only cut off access to abusers, but also identify the problem prescribers." (Read more)

Sen. Rand Paul puts holds on federal synthetic drug bans

U.S. Sen. Rand Paul, left, has put a hold on several Senate bills aimed at banning chemicals used in synthetic drugs because he feels "enforcement of most drug laws can and should be local and state issues," said his spokeswoman Moira Bagley. The move has been criticized by other lawmakers, law enforcement and a woman from his home city whose daughter had a bad reaction to synthetic marijuana. (Photo by Matt Goins)

"When Ashley Stillwell, 19, bowed to peer pressure last August and smoked a substance called 7H, it quickly immobilized her," reports Bill Estep for the Lexington Herald-Leader. "Ashley's frightened friends poured water on her and shook her. When they couldn't rouse her, Ashley heard the others discuss dumping her body in the Barren River."

The teen recovered after she was taken to the hospital, but her mother Amy, of Bowling Green, is frustrated by Paul's move to block the legislation. Three Senate measures passed committee last summer, and the House voted 371-98 in December to approve a ban on synthetic drug chemicals. Senate rules allow one member to place a hold on a bill. "That doesn't mean it can't be voted on, but it slows the process and raises some hurdles," Estep reports.

Bagley said Paul is concerned about banning the substances before research can be done on them. Sen. Charles Grassley, an Iowan Republican who sponsored one of the bills, said reclassifying the chemicals as controlled substances would not prevent research from being conducted. "We cannot let the will of just one senator obstruct the will of many," Grassley said.

One in nine high-school seniors had used a substance known as K2 or Spice in the past year, the National Institute on Drug Abuse reported in December. That makes synthetic marijuana the second most-abused drug in that age group. Calls to poison-control centers about synthetic drugs have risen from 3,200 in 2010 to 13,000 last year, Estep reports.

White House drug chief Gil Kerlikowske said his office is "urging the Senate to pass that legislation." (Read more)

Board suspends license of doctor at raided Lexington pain clinic

DEA agent enters building housing clinic
(Herald-Leader photo by Charles Bertram)

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

The Kentucky Board of Medical Licensure imposed an emergency suspension yesterday on the license of the doctor at a Lexington pain clinic that was raided by the Drug Enforcement Administration on Wednesday.

Dr. Najam Azmat "had little formal training in pain management or primary care, yet he was paid $7,500 a week to write prescriptions for powerful narcotic painkillers" at Lexington Algiatry, a pain clinic on Alexandria Drive, the Lexington Herald-Leader reports, drawing on board documents. The board's order said, "Azmat organized his practice at the Lexington Algiatry Clinic to maximize fraud and abuse, and it appears to be intentional."

The board "acted on an investigation that's been going on for some time," President Preston Nunnelley told the Herald-Leader. Azmat referred the newspaper to his lawyer, Fox DeMoisey of Louisville, who said he could not respond because he had not seen the board's allegations or the DEA's search warrant. "He intends to defend the matter vigorously," DeMoisey told the paper.

Azmat told a board investigator that he was employed by Warren Gold of Tampa, Fla., who owns Lexington Algiatry, for $7,500 a week. Valarie Honeycutt Spears and Josh Kegley of the Herald-Leader report, "Gold provided him with an apartment in Lexington, and Azmat traveled between Lexington and Georgia, where his family lives, organizing his work schedule around his flight schedule, the documents said." (Read more)

UPDATE, Feb. 18: A representative of the clinic "filed to do business under a new name," Kegley reports.

His latest story has more background on Gold, left, who pleaded no contest in Tampa to operating a pain clinic without a license, which at the time (2010) was required only by a local ordinance. His probation ended Dec. 23. He does not have a medical license in Florida or Kentucky, Kegley reports.

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storyli

Judge continues to block graphic images on cigarette packs

Getting graphic labels on cigarette packages continues to be an uphill battle for the Obama administration, as a skeptical judge sided with cigarette makers who say "they can't be forced to spread the government's anti-smoking advocacy with 'massive shocking, gruesome warnings' on products they legally sell," reports The Associated Press.

U.S. District Judge Richard Leon of Washington, D.C., has already decided that the cigarette makers will probably succeed in their lawsuit, because he has ordered the government to not enforce the requirement that the labels appear on cigarette packages next year.

The labels, approved by the Food and Drug Administration, "included color images of a man exhaling cigarette smoke through a tracheotomy hole in his throat; a plume of cigarette smoke enveloping an infant receiving a mother's kiss; a pair of diseased lungs next to a pair of healthy lungs; a diseased mouth afflicted with what appears to be cancerous lesions; a man breathing into an oxygen mask," among others, AP reports.

Leon has indicated he thinks the labels go overboard in their efforts to convey the dangers of cigarettes. He has ruled they are too large; they were intended to cover the top half of packs. "It sounds like they are headed to a place," he said Wednesday, "where you have to watch a 10-minute video before you can even buy a pack of cigarettes." (Read more)

Health insurance exchange benefits will be decided at the state level; Kentucky can now proceed to set up its exchange

For months, Kentucky officials have said the state cannot move forward with setting up a health-insurance exchange under the new federal health law because there weren't enough details about which benefits they had to offer. On Friday, the Obama administration answered that question when it "let states, rather than the federal government, define which medical benefits insurance companies will have to offer consumers starting in 2014," reports Noam L. Levey of the Los Angeles Times. "This is significantly more state-flexible and friendly than many would have expected," Alan Weil, head of the National Academy for State Health Policy, told Levey.

The law says that by 2014, each state must offer an insurance exchange, an online insurance marketplace in which people can choose from a variety of plans from companies like Anthem or Bluecross/Blueshield and then, for the most part, be given federal subsidies to help pay their premiums. About 30 million individuals and employees of small businesses are expected to use the exchanges. The plans in an exchange must cover a basic set of benefits, including hospitalizations, emergency care, newborn and maternity care and pediatric services, but until now the federal government could have decided how generous the benefits had to be.

"Under the guidance issued Friday, state leaders can define their own set of benefits by using an existing major health plan in their state as a benchmark," Levey reports. "That means that some states may require insurers to cover services such as chiropractic therapy and in vitro fertilization, while others may not."

It's this variability between states that worries some. "In passing a good deal of the decision-making to states, the administration has guaranteed that Americans will continue to face a patchwork of state regulations that make coverage uneven and inefficient," report Gardiner Harris, Reed Abelson and Robert Pear in a news analysis for The New York Times.

Some consumer advocates also worry the move will allow states to make benefits too meager. Timothy Jost, a law professor at Washington and Lee University, said the policies "could restrict, for example, the number of covered visits a pregnant woman could make to her obstetrician or which prescription drugs to pay for."

However, by passing the responsibility on to the states, "President Obama will most likely make his plan for health care reform more politically palatable," the Times reporters write. "States will be allowed to set benefits at levels similar to what they are now, making coverage not much more expensive than it is today."

While some Republican state officials were happy with the decision, saying it makes it easier for states to comply with the law, others opposed to the law were critical. "All they're trying to do is avoid making tough calls before the election," said Ed Haislmaier, a senior research fellow at the Heritage Foundation. (Read more)