Advocates: Kentucky Schools Would Feel The Pinch If GOP Revives Health Plan Wednesday, Apr 26 2017 

Public schools would be in a financial pinch if Congressional Republicans are successful in changing the way Medicaid is funded.

The federal Individuals with Disabilities Act requires public schools pay for health care services for students with disabilities — including services like school nurses, speech and mental health therapists. Kentucky schools received $34 million in 2015 toward those costs. Over half of the funds came from Medicaid — the rest came from the state.

That money could be in jeopardy if the American Health Care Act – also referred to as Trumpcare – is revived. The GOP plan proposes cutting $839 billion in Medicaid spending to states over 10 years.

Other changes include funding Medicaid through block grants, which would give states a chunk of money each year to pay for the program. Critics say block grants wouldn’t take into account unexpected public health crises — like a hepatitis C breakout, for example — and it would be up to states to fill in gaps or not.

Brad Hughes with the Kentucky School Boards Association said if federal funding goes away, schools would still be required to pay for health care services for students. He said that could be done by raising taxes or tapping into school general funds that provide other services.

“It could be a devastating unfunded mandate on public schools,” Hughes said. “Then they have to figure out how to pay for it.”

Public schools receive money from the federal government to help pay for health care for children with disabilities but the money also benefits children without disabilities. That’s because if a school nurse is hired, all students at that school likely have access to that nurse.

Having school nurses and other health care professionals in schools also saves money. That’s because when children seek health care at school, parents don’t have to pay co-pays for a doctor’s visit. For parents of children in Massachusetts schools in 2009, those medical costs were valued at $20 million. That’s according to a 2014 study in the Journal of the American Medical Association.

Terry Brooks with Kentucky Youth Advocates said the potential cuts would come to a state that already doesn’t allocate many resources to children’s health care in schools, even though there is a link between education success and health.

“In Kentucky, a real focus on school-based health is very rare,” Brooks said. “It usually boils down to a superintendent who’s thoughtful about the intersection of health and education, and they go to work on making it happen. If we know it’s an idea that’s delivering good services for kids and it’s a win-win, to threaten that is bad economics and bad for kids.”

The cuts could also come as Gov. Matt Bevin makes changes to Kentucky’s Medicaid program. Bevin has proposed monthly payments for all Medicaid recipients, no matter their income, excluding pregnant women and people with disabilities.

That’s concerning to Brooks. He said when parents are insured, they are more likely to also have their children insured. Over 400,000 people gained access to Medicaid through the state’s expansion in 2014.

Kentucky could make up the difference for schools and help them pay for health care for students but Brooks said advocates won’t know what Bevin’s budget priorities are until he unveils his next budget in 2018.

New GOP Health Proposal Could Ditch Protections For People Who Are Sick Thursday, Apr 20 2017 

House Republicans are mulling new changes to their health care proposal, hoping to wrangle enough votes to pass a bill that would allow them to keep their campaign pledge to repeal and replace the Affordable Care Act.

The latest proposal allows states to make changes to the Affordable Care Act’s rules governing health insurance policies and markets, in an effort to allow some states to offer stripped down policies with lower premiums.

The proposal represents a deal between Rep. Tom MacArthur, R., N.J., who is the head of the moderate Tuesday Group and Rep. Mark Meadows, R., N.C., who leads the far-right Freedom Caucus. The two groups could not agree on details of an earlier health care plan championed by House Speaker Paul Ryan, known as the American Health Care Act.

The new proposal, which was reported by Politico and The Huffington Post, is an amendment to that bill. It consists of a summary and bullet points rather than legislative language.

Without the full language it’s unclear whether the plan could bring in enough votes to pass, says a senior House Republican aide.

The proposal retains many of the popular consumer protections of the Affordable Care Act, including ensuring that people with pre-existing medical conditions cannot be refused coverage or charged more.

MacArthur, on his Facebook page, said the plan “will make coverage of pre-existing conditions sacrosanct for all Americans.”

But the plan also allows states to waive those protections.

If states requested waivers, people with pre-existing conditions would likely be covered through state-run high-risk pools, which can be expensive for patients and for taxpayers. Many states used high-risk pools before Obamacare with limited success because they weren’t adequately funded, according to a study by the Kaiser Family Foundation.

The plan “would make coverage unaffordable for many older consumers and would segregate high cost consumers in coverage that would likely be inadequate,” says Timothy Jost, an emeritus professor at Washington and Lee Law School who writes a health policy blog for Health Affairs.

The proposal could also cause premiums to spike for people with medical issues, according comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. A person with diabetes could see premiums rise by about $5,600 while someone with metastatic breast cancer could be charged an additional $142,650, he says.

There are some protections against such premium spikes in the proposal, says Rodney Whitlock, vice president of health policy at ML Strategies who was a Republican Senate staffer when the Affordable Care Act was passed.

He says language that forces states to promise their changes would still protect people with pre-existing conditions, and result in lower premiums, invites people hurt by the changes to sue the state.

The proposal doesn’t mention Medicaid at all, so it may do little to bring in support for the Republican bill. That’s because the American Health Care Act was killed in part because it rolled back Medicaid coverage for millions of low-income people, something moderate Republicans opposed.

“I have a hard time believing that this will be acceptable to moderates in the House, much less the Senate, and will certainly be opposed by all Democrats,” Jost says.

Copyright 2017 NPR. To see more, visit

KentuckyOne cuts 150 jobs, with 100 more employees transferring or retiring Tuesday, Apr 18 2017 

In a continued effort to reduce costs, KentuckyOne Health is cutting 150 jobs, citing a challenging health care environment. The organization also told Insider that 100 additional employees either transferred to University of Louisville Hospital or took early retirement. KentuckyOne could not be reached immediately to provide more details. UofL said the number of employees […]

Downtown Heart Clinic Aims To Fill Void For West, South Louisvillians Monday, Apr 17 2017 

Heart disease is the second most common killer in Kentucky. Prescription drugs can help ward that off; so can having a stent put into the heart.

And despite the expansion of Medicaid in 2014, there are still people who don’t have health insurance, can’t afford their premiums or can’t find a heart specialist because they have Medicaid. For those people, Have a Heart Clinic could be the place to go.

Most of the clinic’s patients come from West and South Louisville, where residents are three times more likely to die from heart disease and stroke than people who live in places like the Highlands or East Louisville. And none of Have a Heart’s patients have insurance.

Michael Imburgia, a cardiologist who started the clinic nine years ago out of his practice in the East End, said most everyone who comes to the clinic has a job. But they tend to have lower-paying jobs that don’t offer health insurance.

He said many make too much to qualify for Medicaid, and make too much to qualify for a health insurance subsidy on And the price of insurance on the individual market can be as high as $5,000 a year for premiums alone.

“The only type they can afford will have a $5,000 deductible, and these are people that only make $20,000 a year,” Imburgia said. “People shouldn’t be treated differently based on the type of insurance they have.”

The clinic didn’t start as a clinic, but out of Imburgia’s office in East Louisville.  And the majority of people he and other doctors would see there for free had to make the trek mainly via the bus from South and West Louisville.

As of February, Have a Heart has a brick-and-mortor location at 310 E. Broadway. Since opening, there has been an uptick of new patients. The clinic sees around 150 patients a year, but Imburgia said he expects to see even more since they now have a more centralized location.

While there are free primary care clinics, and money that goes toward preventive screenings, patients need a place to go when their health condition gets worse. Forty percent of visits at federally qualified health centers are for cardiovascular problems, and yet, almost half of those patients struggle to find a specialist.

“You have a place where no one gets turned away,” Imburgia said. “And right now there is a barrier to people who are underinsured and frankly there’s a big barrier for people who are underinsured.”

Have a Heart provides testing and monitoring with machines that usually cost patients a lot of money when they visit other settings like hospitals. And if patients need more advanced care, including heart surgery, Imburgia looks to the clinic’s 70 volunteers for a doctor to provide services for free at a hospital.

The clinic is also gearing up to see patients with insurance so they can use that money to help pay for treatment for people without insurance.

Public health efforts like anti-smoking campaigns have reduced the number of people who die from heart-related health problems, but health costs across the U.S. have gone up — mainly because of advances in treatment and longer life spans, according to a 2013 study in the Journal of the American Medical Association.

Currently, the Have a Heart Clinic is open from 9 a.m. to noon two to three Saturdays a month.

Tax Day And Health Insurance Under Trump Saturday, Apr 15 2017 

Your federal income taxes are due April 18 this year, and — for perhaps several million people — a fine for failing to get health insurance is due that day, too.

Despite a lengthy debate, Congress has not yet acted on a bill to repeal portions of the Affordable Care Act. That means the law and almost all of its regulations remain in force, at least for now.

For the majority of tax filers, who had health insurance through an employer for 2016 or through a government program, all they have to do is check the box on the 1040 form that says they were covered for a full year. That’s it.

The Obama administration had called for the IRS to begin rejecting tax returns for 2016 that left that box blank. But the IRS under the Trump administration has canceled that policy, citing a Trump executive order that calls on federal agencies to “minimize the burden” of the health law.

Still, those who lacked insurance for more than three consecutive months, or who bought individual insurance and got federal help paying the premiums, need to do a little more work to figure out what, if anything, they owe.

Those with no insurance, and those who have had a lengthy gap in coverage, may be required to pay what the federal government calls a “shared responsibility payment.” It’s a fine for not having coverage, on the theory that even those without insurance will eventually use the health care system at a cost they can’t afford, which means that someone else other patients, hospitals, health care providers and taxpayers — will have to pay that bill.

Many people who don’t have insurance, however, qualify for one of the several dozen “exemptions” from the fine. Nearly 13 million tax filers claimed an exemption for 2015 taxes, according to the IRS. Most often those exemptions came from people whose income was so low (less than $10,350 for an individual) that they are not required to file a tax return, or from Americans who lived abroad for most of the year, or from people for whom the cheapest available insurance was still unaffordable (costing more than 8 percent of their household income).

The fine for 2016 taxes is the greater of $695 per adult or 2.5 percent of household income. Fines for children who lack insurance coverage are half the amount for uninsured adults. Fines are pro-rated by the number of months each person was uninsured.

The maximum fine is $2,676; that is the national average cost of a “bronze” level insurance plan available on the health exchanges. But most people do not pay anywhere near that much. Last year, said the IRS, an estimated 6.5 million tax filers paid a fine that averaged $470.

If you bought your own insurance from the federal marketplace or a state health insurance exchange and you got a federal tax credit to help pay for that coverage, you have to take another step before you can file your taxes.

People who got those tax credits must fill out a form that “reconciles” the amount of subsidies they received based on their income estimates with the amount they were entitled to according to their actual income reported to the IRS.

In tax filings for 2015, about 5.3 million taxpayers had to pay the government because they got too much in tax credits, compared to 2.4 million who got additional money back. But among those who underestimated their incomes and had to pay back some of those tax credits, 62 percent still received a net refund on their taxes.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Copyright 2017 Kaiser Health News. To see more, visit Kaiser Health News.

Breakfast with the Fed: Jobs for the middle class swing low and high Friday, Apr 14 2017 

While the national unemployment rate has returned to recent historical norms of about 4 percent, the economy needs to add another two million jobs before it reaches full employment, a Federal Reserve economist said in Louisville Thursday. David Andolfatto, vice president of the Federal Reserve Bank of St. Louis, also said that the number of […]

Amid Louisville’s Heroin Battle, Volunteers Of America Expands Treatment Programs Thursday, Apr 13 2017 

Volunteers of America is expanding its addiction treatment programs in Louisville.

Freedom House, a residential treatment program for mothers and pregnant women, will get more space at the former Planned Parenthood on Second Street. The program will also provide family and group therapy, case management and psychiatric care.

VOA is also set to open a second facility next month at 4303 West Broadway, which will provide transitional living for women with drug addiction issues.

Tiana Brigs came to Freedom House two months ago after a three-year battle with prescription opioid addiction. She had her sixth child four days ago. At the groundbreaking Thursday morning, Brigs said it meant a lot to her that there will be more places to go for people with addiction.

“I would go to the hospital and lie, and say I was in pain just to get pain medicine,” Brigs said. “They usually give it to you after you have kids; that’s how I started using. I used to buy it on the streets after that.”

Brigs is from Louisville and many of her friends have battled drug addiction.

“There are so many people out here dying, and it could be me. Don’t nobody want to see anybody go down like that for drugs,” she said. “And just having nowhere to go, it’s pretty painful. But to open another Freedom House, in the West End, where it’s all going down at, it’s a blessing.”

VOA is also expanding an existing facility at 2500 East Broadway to include intensive outpatient treatment and aftercare services.

Yvette Gentry, chief of community building with the mayor’s office, said addressing addiction as a public health crisis is the only way the city will make progress. Gentry said children who had parents in the 90s who were addicted to crack cocaine are now filling juvenile detention centers.

Jonese Franklin

Residents, city leaders and members of the community gathered for VOA’s groundbreaking.

Andrew Davidson, a social worker and director of clinical services for VOA Midstates, agreed. He said children of parents who have addiction are more likely to also have addiction issues.

“We know that addiction is multigenerational, it’s passed on — it’s just like any other illness,” Davidson said. “Now it’s more to the forefront because people are dying from this disease. That’s why it’s so important when we’re doing addiction treatment we treat the whole family, we don’t just treat the addict.”

Lawmakers May Override Bevin’s Veto Of Mental Health Bill Wednesday, Mar 29 2017 

Kentucky senators are considering overriding a veto by Gov. Matt Bevin of a bill – known as “Tim’s Law” — that would allow a court to order involuntary outpatient mental health treatment.

The bill is named after Tim Morton, a Lexington man who had a serious mental illness. He also had a neurological condition called anosognosia that left him unable to recognize he had an illness.

The bill would affect people specifically with that condition, and who had been involuntary committed to a hospital for treatment. Anosognosia commonly occurs among people with bipolor disorder and schizophrenia.

Bevin vetoed the bill Monday night, writing in his veto position statement that no one should be involuntarily ordered to treatment if they haven’t committed a crime or aren’t a danger to themselves or others.

The veto was a shock to mental health advocates — the bill passed the Senate with three dissenting votes and with no dissent in the House. Advocates gathered in the Capitol on Wednesday to ask lawmakers to override the governor’s veto.

Sheila Schuster is executive director of the Kentucky Mental Health Coalition.

“[Morton] died at 46 of self neglect and neglect by the system because the involuntary commitment didn’t keep him in treatment long enough that he could begin a road to recovery,” Schuster said. “We’re trying to avoid that revolving door by catching people before they’re a danger to themselves or others.”

The Senate needs 20 votes to override, and the House 51.

Republican Sen. Julie Raque Adams of Louisville is pushing for an override of the veto.

“It’s not as if we’re randomly selecting people who may or may not have a mental illness,” Adams said. “This is a very specified population that is spelled out.”

Legislators have until Thursday to override the veto.

Reality Check On Trump Calling For Bipartisanship On Health Care Wednesday, Mar 29 2017 

The fallout from Friday’s Republican health care bill collapse is still trying to be understood.

Right after the bill was pulled, President Trump teased that he wanted to work with Democrats and believed a bipartisan bill would be possible.

But it wasn’t clear if that was just talk. On Tuesday night, he may have taken the first step to trying to reach across the aisle.

“I know that we’re all going to make a deal on health care, that’s such an easy one,” Trump told a bipartisan group of senators gathered at the White House. “I have no doubt that’s going to happen very quickly.”

Speed is relative. The Trump-Paul Ryan health care bill was fast-tracked and collapsed in 17 days. It took President Obama more than a year to pass the Affordable Care Act, with more members of his own party in the Senate than Republicans have now.

“We have all been promising it — Democrat, Republican — to the public,” Trump said Tuesday night.

That’s the rub for Republicans. Health care has been one of the most hotly partisan issues of the past decade. It has been the issue that has animated Republican opposition to Obama. The prospect of repealing and replacing Obamacare has been so critical to Republican success, it is arguably responsible for hollowing out the Democratic Party.

Obama’s focus on instituting the law gave the Tea Party a clear focus.

“What brought everything together was the Obamacare idea, which contains every odiferous objection,” Mark Williams of Tea Party Express told CNN in August of 2009.

It was a staple of every Tea Party rally through that election cycle, so it is unlikely the GOP base shrugs its collective shoulders and moves on the way Trump promised to do Thursday and Friday – and wait for Obamacare to “explode.”

Waiting for the bill to fall apart puts Republicans in a terrible bind. Trump could get it left, right and center. If the Trump administration doesn’t work as hard as it can to implement and administer the law, and you start seeing reporting from unnamed career officials verifying that, it very well could mean the Trump administration is blamed for harming real people’s lives.

That would enrage not just Democrats, but independents and some Republicans.

If the Trump administration does administer the law the way the Obama administration did, the GOP base would likely be enraged, especially without a repeal-and-replace option. Is this what they voted for all these years?

“We are going to be doing a great job,” Trump added in his remarks to senators Tuesday night. “Hopefully it will start being bipartisan, because everybody really wants the same thing. We want greatness for this country that we love.”

But there is little muscle memory for anything bipartisan with this Congress. And there are challenges.

Democrats may be open to it, but Senate Minority Leader Chuck Schumer said only if repeal is off the table. Would Republicans in Congress be OK with that? Maybe some, but it’s unlikely — and could cost Ryan his job as speaker if he doesn’t have the majority of his conference and winds up working with Democrats.

Plus, congressional Republicans viewed Trump’s election as their chance – finally – to enact sweeping changes with traditional Republican agenda items. They won’t give that up easily.

NPR’s Susan Davis noted Tuesday that congressional Republicans are insisting they are closer now to passing health care than they were Friday and aren’t giving up, reversing course on the tone Ryan took Friday that Obamacare is now “the law of the land.” But, as Davis put it:

“House Republicans’ optimism that they could find a GOP-based solution to health care is undercut by comments this week by the White House and Senate Republicans who say any future health care legislation will likely require Democratic support — a tacit acknowledgement that repealing Obamacare is off the table.”

Will Trump really force their hand on “repair”? So far, there’s no real evidence of that. His whole presidency to this point has been bold appeals to his base, not reaching across the aisle.

What’s more, would rank-and-file Republican voters be OK with it? They’d be skeptical, and it’d be up to Trump to make the sale – something he didn’t do the first go-round with health care.

“Bipartisanship” is just an idea at this point. There is no discernible White House strategy for getting a bill through right now, and no evidence to suggest his team could shepherd it through.

Trump took a first step Tuesday night. He acknowledged Schumer, whom he hasn’t spoken with since shortly after the inauguration.

“I think we are going to have some very good relationships — right, Chuck?” Trump said. “I see Chuck. Hello, Chuck.”

But, as the health care failure showed, legislating is a lot harder than talking.

Copyright 2017 NPR. To see more, visit

U.S. Attorney Issues Recommendations To Combat Louisville Heroin Epidemic Tuesday, Mar 28 2017 

A summit on addiction held last winter at the University of Louisville has produced a slew of recommendations for overcoming the heroin and opioid epidemic in Kentucky.

Statewide, the number of fatal drug overdoses has nearly doubled since 2009. And as WFPL News has reported, in Louisville alone, 362 people died last year from overdoses.

The U.S. Attorney’s office for the Western District of Kentucky released the recommendations Tuesday.

U.S. Attorney John E. Kuhn said efforts to prevent drug use by young people must be intensified and access to treatment must be improved.

“Only two things can defeat us in our battle against this epidemic: a lack of commitment and a failure to collaborate,” Kuhn said via news release. “A serious and sustained commitment to resolve this crisis will bring us the resources we need, and our collaboration will broaden our impact immeasurably. Together, we can build a healthier community and bring this destructive chapter to an end.”

Among the recommendations from the report:

  • Addiction treatment should be available for all persons seeking treatment.
  • Prevention programs built upon evidence-based principles should be offered in all schools.
  • Education outreach to the general public concerning opioid risks, addiction, and treatment should be expanded.
  • Law enforcement should improve and intensify efforts to eliminate the supply of heroin, fentanyl, opioid analogues and diverted pharmaceuticals.
  • All sectors working on and affected by the heroin and opioid problem should collaborate to share data and information even if not mandated to do so.
  • Kentucky should establish a comprehensive, centralized drug data collection, analysis and sharing system.
  • Recovery support programs and systems should be developed in schools and throughout the community.

The full report can be found here.

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