Bill To Remove Barriers To Smoking Cessation Benefits Awaits Governor’s Signature Thursday, Mar 16 2017 

Smokers could have an easier time kicking the habit thanks to a measure passed by the Kentucky General Assembly this week.

Though insurance companies already offer aids including nicotine patches, the bill would prevent insurers from charging co-pays, requiring prior authorization or step therapy — a program that encourages the use of the least expensive drug before moving onto more costly drugs — to gain access.

The legislation now awaits Gov. Bevin’s signature.

Kentucky has one of the highest rates of smoking in the country, a cost of $1.9 billion a year to the health care system. That includes $590 million in Medicaid according to Tonya Chang, advocacy director with the American Heart Association.

Chang said the requirements insurers were using are not backed by research.

“I’m not aware of any science that supports step therapy in smoking cessation,” Chang said. “Those treatment decisions are best left in the hands of doctors.”

The legislation, sponsored by Republican Senator Julie Raque Adams of Louisville, would remove those requirements that are recommended by the United States Preventative Services Task Force.

Smoking cessation benefits became a requirement of coverage for exchange plans when the Affordable Care Act, also known as Obamacare was passed. Most employers and Medicaid plans also offer them.

However, if current legislation in Congress passes, the bill may not benefit as many people.

The GOP-led American Health Care Act, also being touted as Ryancare and TrumpCare, would eventually stop paying Kentucky and other states money for Medicaid expansion beneficiaries. That would mean while Kentucky could keep coverage for people up to 138 percent of the poverty limit, it would be up to the state to foot the bill.

The Congressional Budget Office this week said that compared with current law, under the Republican replacement plan 14 million more people would be uninsured by 2018, and 24 million more would be uninsured by 2026. So, the fewer the people with coverage, the fewer who have access to smoking cessation aids.

Chang with the American Heart Association said their focus is now on increasing the cigarette tax. It is currently 60 cents. In order to see a decline in smoking rates, the tax would have to be raised to $1.60, according to an October report from the journal Health Affairs.

The AHA and other public health groups also targeted a smoke-free schools bill that would have banned smoking on public school property. That bill did not pass the General Assembly.

In Other News…McConnell’s not-so-happy homecoming, Cardinals woes and Lawrence’s ‘biggest Oscar moment’ Friday, Feb 24 2017 

Homecoming: USA Today, The Seattle Times, New York Magazine and NPR say this week, on his trips through his home state of Kentucky, Senate Majority Leader Mitch McConnell has received somewhat of a mixed reception. At a Chamber of Commerce luncheon in Lawrenceburg, Rose Mudd Perkins, had some thoughts for the senator, says U.S. News […]

Troubled Waters: A Coalfield County Loses Trust In Water And Government Monday, Jan 30 2017 

On any given day in Martin County, Kentucky, the water system loses more water to leaks than it delivers to paying customers through their faucets. The system is under a state investigation for the third time since 2002. Customers complain of frequent service interruptions and discolored water, and their bills come with a notice that drinking the water could increase the risk of cancer.

This is the state of infrastructure in a county that’s mined many millions of dollars worth of coal since the early 1900s, providing the power required for America’s industries and modern comforts. As with many coalfield communities, all the profit and advances the area’s laborers and natural resources made possible haven’t left much evidence of improvement in the local economy and infrastructure.

Opening a tap is an exercise in trust which most of us take for granted. But in Martin County it’s just one more reason for residents to feel let down by the powers that be — one more chapter in the long story of how the people have lost faith in their government.

Alexandra Kanik | Ohio Valley ReSource

Dirty Water and Distrust

Josie Delong lives in Warfield, Kentucky, which is one of Martin County’s bigger towns with a population of 269. Because it’s across a ridge line from Martin County’s water intake near Inez, the county seat, Warfield has had some of the worst recent water struggles in Martin County.

“We drink nothing but bottled water,” Delong said. “I even put bottled water in my kids’ bathroom when they brush their teeth.”

A lot of people in Martin County won’t drink the tap water. Peggy Newsome, a clerk at the local Save-A-Lot supermarket, estimated that at least 75 percent of the people she checks out buy bottled water.

Delong said the water has long had a chemical smell and she worries that it might be contributing to her health problems, including bleeding ulcers.

“So I go to my doctor and the first thing he says is, ‘Contaminated water. How’s your drinking water?’” she said. “Is it caused by the water? I can’t say that 100 percent, but my belief —  it is.”

Courtesy Josie Delong

Josie Delong with a sign used as part of her advocacy for cleaner water.

Delong is among many residents who say they have seen water service cut off at times with little or no notice.

The service interruptions relate to the system’s inability to meet peak demands for water. For example, when the temperature drops below freezing, many people leave their taps open to make sure pipes don’t freeze. That creates peak demand on the water system, and last winter in Warfield, it was enough to drain the water tanks.

That left Joe Hammond with a dilemma. Hammond is the public face of the Martin County Water District. He said the lack of water would force the local school to close.

Courtesy Mountain Citizen

A still image from a video of foul water in a Martin County home.

“At night they would shut it down so that they’d have water for schools,” Hammond said.

Before you use water after a loss of service, it’s best to flush the pipes to get out any dirt that’s seeped inside in the meantime. But you can only do that if you know your water’s been cut off.

Hammond said it was a quick decision late at night to shut down water to the Warfield area and that explains why a notice, known as a boil water advisory, didn’t go out until until the next morning.

Delong and others say they never heard anything about a notice, not for that night or for any of the following nights when the water was again cut off.

The problem with stopping water flow to a section of pipes is that there’s no longer any water pressure to keep out contaminants. That’s especially true in Martin County, where the pipes are so leaky that the water-loss rate has consistently been over 50 percent.

Benny Becker | Ohio Valley ReSource

Joe Hammond of the Martin County Water District took questions at a hearing on water problems.

Last June, Martin County State Sen. Ray Jones called in several top state officials for a public meeting to address the county’s drinking water issues. The water district’s Hammond tried to explain the county’s system for calling customers affected by a cutoff or boil water advisory. But he was cut off by angry audience members. One man said he’d never heard of anyone getting such a warning. “I’m done with it, it was a lie!” the man shouted and stormed out of the room.

Sewage Stressing System

The other top issue at the public meeting was concern over two disinfection byproducts, Trihalomethanes and Haloacetic acids. Since 2002, these have been showing up on notices sent to customers of the Martin County Water District. The notices inform customers that their water has exceeded maximum contaminant levels, and that long-term exposure can increase the risk of cancer, especially for the elderly, infants and anyone with a compromised immune system.

According to Joe Burns of the Kentucky Rural Water Association, disinfection byproducts aren’t an issue for most U.S. water systems that draw from groundwater. In Kentucky and the Ohio Valley region, however, many systems draw water from rivers and streams, which opens up more possibility for contamination that needs to be treated with chlorine.

The disinfection byproducts are the result of chlorine interacting with organic molecules. Much of the organic molecules come from what are commonly known as “straight-pipes”. In Martin County, like much of the coalfields, there’s a serious shortage of wastewater infrastructure, which means sewage often gets piped straight into the nearest stream.

Benny Becker | Ohio Valley ReSource

Martin County’s water intake on the Tug Fork River.

Gail Brion directs the University of Kentucky’s Environmental Research and Training Laboratories and has worked on water treatment issues for decades. She calls the amount of sewage in this region’s watershed “as close as I could come to Third World conditions without a passport.”

More sewage in the water source means more chlorine is needed. Nina McCoy, a retired biology teacher, has been testing water around Martin County for nearly 25 years. She said the frequent violations for high levels of disinfection byproducts is an indication of the poor quality of the water  coming out of the county’s water treatment plant.

“We’re constantly being told, this is basically your own crap,” McCoy said.

Officials have tried to reassure the public that disinfection byproducts shouldn’t make them afraid to drink their water.

Peter Goodman, the Director of the Kentucky Division of Water, was at the June meeting in Martin County. He tried to reassure the crowd that they’re not at any great risk. He said the levels are just a little over the standard, that the standard is very conservative, and that since it was recently strengthened many water districts are dealing with the issue.

At the Martin County Water District Office, Hammond shared a handout that emphasizes that the risk of cancer from disinfection byproducts is small and a worthwhile trade-off if the alternative is water that could potentially make you sick right away.

Coal’s Contamination

Martin County’s major industry has also caused massive contamination of surface waters.

Courtesy Ohio Valley Environmental Council

The Martin County Coal slurry spill in 2000.

Leaks and spills from coal mines and gas drilling operations are common. Many are minor, blackening a stretch of stream or producing mysterious, short-lived slicks. Other spills are disastrous.

That was the case on Oct. 11, 2000, when a massive coal slurry impoundment, or sludge pond, broke through an old mine shaft underneath. Wolf Creek and Coldwater Creek ran black with sludge, overflowing their banks by up to seven feet, and the millions of gallons of sludge forced the closure of drinking water intakes along miles of downstream rivers.

A decade later, residents could still find residue of the sludge along streams just a few inches below the surface.

The spill and the way it was handled by authorities has further eroded people’s trust in both the county’s water and its leaders.

Some residents complained that there was little warning for residents at the time of the disastrous spill, and a mine safety investigation of the incident was mired in scandal and accusations of a cover up to protect the coal company.

A War on Poverty Battlefield

Now, Martin County is in a really tough situation. Forty percent of the county’s residents live in poverty. Only 30 percent are in the workforce. The coal industry has been laying off workers as it competes with cheaper natural gas, depletes the best coal seams, and relies more on machines.

Hard times here are nothing new. Martin County has been facing many of the same economic and infrastructure challenges for decades and was a highly visible part of one of the country’s most famous efforts to address poverty.

In 1964, President Lyndon Johnson visited Martin County as he launched the War on Poverty. A government film described it as “a trip to the root of Appalachian poverty” and noted that the area’s economic hardship was “attributable primarily to a general lack of industrialization and losses in the coal mining industry.”

LBJ Library/public domain

President Lyndon Johnson on the porch of a Martin County home in 1964, as he launched his “War on Poverty.”

The  War on Poverty did lead to significant investment that had measurable benefits,  but many have lamented that Johnson’s program did not have the impact it aspired to.

“Here’s the thing, in 1964 LBJ kicked off the War on Poverty,” said Gary Ball, editor of Martin County’s weekly newspaper, The Mountain Citizen. “Here we are, over 50 years later and we can’t even get decent drinking water.”

Tight Budgets

Coal’s decline has had an enormous impact on county budgets across Central Appalachia.

Judge Kelly Callaham, the top elected official In Martin County, said the the local government has been forced to make a lot of cutbacks. He said the county is now getting less than a quarter of the tax revenue from coal that it got as recently as three years ago.

“If somebody’d looked at me when we was getting $800,000 a quarter and said, ‘Judge, you’re not gonna get but $150,000 three years down the road,’ I’d say you’re crazy man,” Callaham said. “But that’s what happened.”

That drastic loss of income makes it harder to pay for water system improvements.

The judge said the quick change in coal tax revenue surprised him, but some in the community were unhappy with how the county has handled its funds. Newspaper editor Gary Ball said county leadership should have been better prepared and made better decisions. He pointed to the county’s recent investment in a $10 million government center as money that could have been better spent improving the county’s water system.

Judge Callaham said he wouldn’t have supported building the courthouse if he’d known how much tax revenue the county would soon lose. He also argued that the old courthouse needed to be replaced because it had issues with lead and asbestos that he suspects caused his health problems.

Benny Becker | Ohio Valley ReSource

The new $10 million government center (right) beside the old courthouse (left).

The dispute over spending priorities is just one more example of the strained relationship between residents and officials. “People just aren’t trustful of their political leaders,” Ball said. “And when you think about it, the leaders haven’t given them a whole lot to win that trust.”

Some Improvements

Martin County’s water district is getting help from the Kentucky Rural Water Association, thanks to the state’s Division of Water. The association has sent in technicians to train and assist the county on detecting and repairing leaks.

Joe Hammond said he’s hopeful that this will help the county’s water loss rate continue to drop — it’s approaching 50 percent after previously topping 60 percent. But Hammond said there isn’t enough money to make the kinds of fixes that are really needed and the patches being made are short-term at best.

“If you have a hole already, it’s just going to get bigger,” he said.

Benny Becker | Ohio Valley ReSource

Martin County relies on a water treatment plant that was built in 1968.

Hammond has a list of prospects for funding. Two options come from the state government — the Kentucky Infrastructure Authority and the Department for Local Government. Those are unlikely to provide the large amounts needed to renovate the treatment plant and start replacing pipes that have been in the ground for as long as 50 years. But they are becoming more plausible now that the water district has submitted the required financial audits.

Hammond and others in the community seem to have their hopes most firmly set on money from the federal Abandoned Mine Land fund. A proposal pending in Congress, the RECLAIM Act, would allow spending from that trust fund for projects in the region that improve economic possibilities.

Gail Brion has experience with federal funding for water systems from her time working at the Environmental Protection Agency. She says the EPA used to provide a lot more federal money for water systems in places like Martin County, but there was a fundamental shift in how the agency approached funding during the Reagan administration, when she describes the EPA as having gone through a “great dismantling.”

Brion said she’s bothered by how America’s priorities have changed when it comes to water systems and other infrastructure.

“These water systems were established with federal money,” Brion said. “That money has now become a revolving fund that has to be paid back. And when you can’t pay for your services to begin with, how are you going to pay back a loan to make those services better?”

Brion said she hopes there’s a growing consensus about the importance of investment in the country’s infrastructure. But she’s not sure that will include things such as water systems.

Benny Becker | Ohio Valley ReSource

Gail Brion directs the Environmental Research and Training Laboratories at the University of Kentucky.

Fighting for Change

Sadly, the issues in Martin County aren’t that exceptional. Counties across the coalfields and in other rural areas face similar challenges of poor infrastructure, lack of investment, declines in the industrial job base and polluted watersheds.

Despite the many problems with its drinking water, Martin County doesn’t stand out as a worst case. In 2016, the Martin County Water District reported 10 water quality violations and 19 boil water advisories. That puts the county below average compared with other Kentucky water systems and the number of reported advisories.

Where Martin County does stand out is in its community of hell-raisers: The Mountain Citizen highlights water issues week after week; Josie Delong formed a Martin County Water Warriors Facebook community; and many other outspoken local activists are making noise.

So while there’s still a lot that needs to be done for the people of Martin County to regain trust in their leaders and their water, one thing is certain: The county has an active community fighting for change, and for clean water.

Behind closed doors: transgender bill endangers students Monday, Jan 23 2017 

By Jahnai Brown —

Behind closed stalls, for lack of better words, we find ourselves in a very personal and intimate situation.

Restroom stalls hide us away from the view of others, allowing us a place to comfortably relieve our bodies. Yes, the controversial and highlighted topic that seemingly slipped through the cracks has risen again. In Kentucky, only three days into 2017, the Transgender Bathroom Bill (House Bill 106) was introduced. It requires that public schools and state universities, along with local and state governments, to designate bathrooms they control “to only be used by persons based on their biological sex.” This means that transgender persons will be required to use the restrooms in regard to their biological sex and not preferred gender.

The bill’s effects to transgender and non-binary people could be devastating. According to the 2015 U.S. Transgender Survey, 59 percent of transgender people avoid using public restrooms because they were afraid of having issues.

Thankfully, the University of Louisville prides itself on being accepting and welcoming to all.

“We’ve made a strong commitment here at U of L to inclusion and respect. In fact, our diversity vision statement affirms that U of L ‘strives to foster and sustain an environment of inclusiveness that empowers us all to achieve our highest potential, without fear of prejudice or bias,'” Assistant Provost for Diversity and LGBT Executive Center Director Brian Buford said.

The business that goes on behind closed stalls is your own. Bills like this can reach outside transgender people. Anyone who doesn’t follow societal rules about how the genders are supposed to look can be targeted. The worries of using public restrooms may vary from place to place, but because of this bill, there may be more worries to come for everyone.

“We’ve greatly increased the number of single-stall, gender inclusive restrooms over the years and have a long-standing agreement with our administration that all new building construction would include these options and that they would also be family-friendly and fully accessible. The renovation of the Student Activities Center is a great example of how we are making progress in this area. The old SAC had no gender-inclusive options, but the new facility will have them on every floor,” Buford said.

Hopefully other places and schools follow suit, allowing everyone to feel safe and included. “We still have work to do, of course. But I’m so proud to be part of a university sticking to its statement.

“We still have work to do, of course. But I’m so proud to be part of a truly inclusive Cardinal community that cares about every member,” Buford said.

File photo / The Louisville Cardinal

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Bevin’s unilateral action sets a dangerous precedent Monday, Jan 23 2017 

By Benjamin Hacht —

Pointing fingers is a trademark for the politically ambitious, but who is really at fault for the University of Louisville’s probationary state and continued controversy?

Kentucky Attorney General Andy Beshear blames Gov. Matt Bevin for accreditation woes at U of L. Bevin, in turn, cited board dysfunction as the root of the problem, defending his decision to unilaterally in abolish the board of trustees last June.

Bevin’s action was later ruled illegal by Franklin Circuit Court Judge Phillip Shepherd. It has since been the focal point for U of L’s probationary status with the Southern Association of Colleges and Schools.

It is evident that the original board of trustees had its issues. Primarily, its lack of  proportional representation of racial minorities and partisanship, which violates state law. It is also possible there was some dysfunction among board members.

Understandably, Bevin attempted what he thought would be a quick fix by dissolving the dysfunctional board and creating a new one complying with state requirements for representation. However, Bevin’s decision to act unilaterally has had serious repercussions for the university and ultimately threatened its accreditation status with SACS, which placed U of L on probation in December.

SACS cited Bevin’s actions as the sole reason for U of L’s probationary status, and said four of the agency’s accreditation standards were violated by the governor’s acts. Bevin took to the media last week to downplay the hysteria created by SACS ruling and support the state legislature’s new statute closely mirroring his actions in June.

Bevin maintains the abolished board of trustees is to blame for U of L’s woes and that his actions, currently awaiting appeal in Kentucky’s Supreme Court, were justified.

Bevin’s refusal to admit his wrongdoing is reckless and problematic. Not only has the Franklin Circuit Court ruled his actions illegal, but SACS blamed Bevin for U of L ‘s probation, the most serious sanction that can be handed to a university before it loses accreditation. Clearly, Bevin’s attempt to maintain his innocence is a political maneuver and an attempt to save face.

Bevin endangered the University of Louisville through his desire to control the makeup of the board of trustees, a direct threat to the accreditation at U of L and all of Kentucky’s colleges and universities. It is clear Bevin believes he was elected to run Kentucky’s colleges and universities. Evidently, the state legislature agrees.

On Jan. 17, Bevin used his newfound power to appoint 10 members to U of L’s board, an act made possible by Senate Bill 12. This is a dangerous precedent and threatens the integrity of higher education in Kentucky.

Bevin’s hasty actions will not do anything to solve the accreditation problem at U of L. Even if U of L’s probation issues are resolved, the governor cannot have the power to abolish and redesign the fiduciary boards of higher education institutions when he chooses. It will prevent institutions from providing quality education absent of undue political influence and external pressure, an issue at the core of accreditation and institutional integrity.

Bevin’s excuses and justifications fall on the ears of students, faculty, staff and alumni struggling to understand how the actions of one man have potential to destroy the value of their degrees, their hard work and the integrity of their university.

It is time for the governor to be held accountable for his actions, and it is time for Bevin to collaborate, rather than dictate, with U of L, SACS and the state legislature to find the best solution to preserve the integrity, reputation and accreditation of U of L. If Bevin’s power is not curbed soon, a dangerous precedent will continue.

The post Bevin’s unilateral action sets a dangerous precedent appeared first on The Louisville Cardinal.

Confederate statue moving to Brandenburg Tuesday, Nov 15 2016 

By Kyeland Jackson —

U of L’s controversial confederate statue has a new home: Brandenburg, Kentucky.

Mayor Greg Fischer’s office announced the move in a news release Tuesday, stating the statue is moving to a Civil War site in Brandenburg, Kentucky. A time capsule, supposedly embedded in the statue, will be loaned to the Filson Historical Society.

“This new location provides an opportunity to remember and respect our history in a more proper context,” Fischer said. “And it’s close enough that Louisvillians can visit.”

Acting President Neville Pinto commented on the statue’s removal.

“We are pleased that Louisville Metro and the city of Brandenburg are working to ensure a proper and fitting location for the statue,” Pinto said. “While we do not wish to erase history, the University of Louisville is looking to a future that embraces and promotes diversity and inclusion for all our faculty, students and staff.”

The Brandenburg City Council and Meade County Fiscal Court are expected to vote on accepting the statue Wednesday. If approved, disassembly, expected to take a week, will begin Saturday. The statue would then be moved to Brandenburg the week of Nov. 28.

Located between Third Street and the Speed Art Museum, the statue was gifted to Louisville by the Kentucky Women’s Confederate Monument Association in 1895 and commemorates confederate Kentuckians who fought and died in the Civil War.

The 121-year-old statue was first slated for removal by former U of L President James Ramsey and Mayor Greg Fischer seven months ago. Controversy ensnared the statue since, drawing protestors, litigation to stop the move and verbal blows between advocates and detractors. The statue’s removal was later approved, leaving the unanswered question of where it would relocate. Fischer chose Brandenburg based on recommendations by Louisville’s Commission on Public Art.

Removal of the statue will shut down Second and Third Street from Nov. 19-23. If disassembly is not completed in time for the U of L and UK football game, one lane will open for both directions.

This story will be updated.

File photo / The Louisville Cardinal

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Anthem Is Reducing Insurance Exchange Plan Benefits In Kentucky Friday, Oct 21 2016 

Kentuckians in more than half of all counties who buy insurance through next year will have a much more limited choice of doctors and hospitals.

That’s because the only insurer left in Kentucky offering exchange plans in all 120 counties — Anthem Blue Cross Blue Shield — will only offer an HMO plan in 74 of those counties starting Jan. 1.

An HMO plan means cheaper coverage in exchange for fewer doctors to choose from. Enrollees will only be able to go to an in-network doctor, which means the provider has agreed to be paid less in exchange for seeing a larger number of patients. Going to a doctor outside the network would mean none of the cost is covered.

“HMOs were created many years ago, but there were 30 choices. So if you couldn’t get into the network [with your provider], you just chose another type of plan,”said Jude Thompson, and insurance broker in Louisville. “We don’t have that. Choice is gone. We have Anthem, and we have Anthem.”

A spokesperson for Anthem said the move was in response to changes in the “health care environment.” United Healthcare, Baptist Health Plans and Aetna have pulled out of the market in Kentucky, citing the inability to make money.

“With the recent changes in the health care environment, Anthem has responded with new products offered through Kentucky’s Health Benefit Exchange and will offer PPO plans in 46 counties, and HMO plans in 74 counties,” said Mark Robinson, public relations director with Anthem.

Humana is only offering exchange plans in Jefferson County, and CareSource will offer plans in some counties. [Story continues below graphic]

Large swaths of the state will be affected — the entirety of Eastern Kentucky and counties surrounding Louisville, Lexington, Owensboro, Bowling Green and Paducah. More than 85,000 people had exchange coverage this year in Kentucky.

Rural areas will be most affected by the reduced choices. For instance, in the Eastern Kentucky city of Louisa — population 2,482 — the Three Rivers Medical Center won’t be in the Anthem HMO network. Instead, exchange enrollees would have to drive 31 miles north to Kings Daughters Medical Center to go to the hospital.

“It’s unfortunate to see they’re leaving the Kentucky market with so few options,” said Emily Beauregard, executive director of the advocacy group Kentucky Voices for Help.

Joel Thompson, an insurance broker in Ceredo, West Virginia, on the border with Ohio and Kentucky, estimates he has 60 clients enrolled in exchange plans. A majority of these are from Kentucky, and a little less than half picked an HMO plan last year because it was cheaper.

But he said he had several clients who specifically asked for a plan with their doctor in-network and so had to splurge on a broader-network plan that was more expensive. That won’t be an option this year.

“There are a number of people that have providers that they swear by, cardiologists and other very specialized physicians that are not HMO. And they’re really going to be hurting this year,” Thompson said. “And that’ll be devastating for a lot of people.”

30 Miles or 30 Minutes

Kentuckians who are enrolled in HMO exchange coverage will still be able to access emergency care at their local hospital, but they’ll otherwise not have insurance cover out-of-network medical providers.

The state also has an “Any Willing Provider” law that lets any doctor or hospital join an insurance plan if they accept the payment rate on the table.

But because these plans on principal pay a low rate, it might not be in the interest of a hospital to be in-network.

Jude Thompson, president and partner at health insurance brokerage Agency One in Louisville, said having an HMO-only network can work if providers are taking new patients.

A 2015 survey of 1,257 primary care physicians by the Kaiser Family Foundation found 14 percent of doctors weren’t taking new patients. Pair that with a more limited network with more patients being sent to providers.

“Here would be the issue: If a physician practice is already at 100 percent, they don’t have to accept new patients,” Thompson said. “That’ll be the domino effect.”

The choices left were not the intention when the Affordable Care Act was approved by Congress in 2010. There were supposed to be a lot of options, according to the theory supporting the law.

The Kentucky Department of Insurance enforces regulations regarding network adequacy, which say an enrollee must be able to access a hospital and primary care within 30 miles or 30 minutes of the person’s home or work.

“They want people to have access to a plan, and if that’s the only option, they obviously want that to be available, especially when there is a law requiring insurance,” said Nancy Galvagni, senior vice president of the Kentucky Hospital Association. “What are people supposed to do if there’s no plan offered and you’re under a law that says you have to be insured? I’m sure it’s a balancing act for the Department of Insurance.”


Are Kentucky Doctors At A Disadvantage Under New Medicare Reg? Monday, Oct 17 2016 

Whether or not your doctor stays in business over the next few years could hinge on their ability to adapt to a new regulation changing how Medicare pays doctors and clinicians.

The game-changing regulation aimed at paying medical providers for quality instead of quantity is known as MACRA. It’s based on legislation passed last year by Congress to overhaul how Medicare pays doctors.

There are two routes medical providers can take: Medical practices can earn higher reimbursements if they learn new ways of doing business. That includes being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records. The majority of medical practices will go this route, according to the Kentucky Medical Association.

Or they can join a network of medical providers and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending.

How it works

Every time a medical provider bills Medicare for a patient, the provider gets paid a lump sum regardless if the patient gets better. Most insurers pay this way. Under the new regulation, the federal government will give bonuses to providers if they use electronic medical records and report quality measures that patients are improving.

Patrick Padgett, executive vice president for the Kentucky Medical Association, said some doctors might already be doing some of the what the rule sets out, but for many, it will be a complete shift.

“It’s asking the medical system to essentially a adopt a new way of operating and documenting and reporting completely different from what they’ve done traditionally,” Padgett said.

Doctors will still be paid for every visit. The bonuses will start out at 4 percent and increase to 9 percent by 2022. At the same time, providers that do not follow the MACRA regulations will get penalized the same percentage.

A 4 percent dock in pay might not sound like a lot but that amount could make or break an independent medical provider’s office. That’s according to Trudi Matthews, managing director of the Regional Extension Center, a federally funded organization that helps hospitals and doctors across Kentucky comply with federal regulations.

“A lot of folks would say they make just enough money to cover the cost of patients,” Matthews said. “They may only have a margin of 2 to 4 percent, so if they’re going to lose 4 percent, that’s a big hit. There aren’t many health care organizations that could take reductions year over year and stay in business.”

Medicare is by far the biggest payer of health insurance claims in Kentucky. The Department of Health and Human Services sets rules for how and how much doctors are paid, and other insurers follow suit.

“Most commercial insurers have announced that they’ll be tying spending to value,” Matthews said. “It’s not just Medicare, it signals a trend in the [health insurance] marketplace.”

Comparing states

Under MACRA, providers can earn bonuses for reporting quality measures. The government will use this as a means of gauging how well a medical provider is improving a patient’s health outcome. For example, providers can earn bonuses for keeping track of patients who have schizophrenia and whether or not they take their medication on a daily basis. Or measuring a hyperglycemia patient’s blood glucose levels.

Most quality measures adjust if a patient is very sick in the beginning but improves. They also adjust based on age and gender. But most measures don’t take into account if a patient lives in a bad neighborhood, far from a pharmacy or doesn’t have reliable transportation to the doctor for follow-ups. In 2015, Kentucky ranked in the bottom five states with the most people living in poverty at 19.1 percent.

These factors can put Kentucky doctors at a disadvantage. And Padgett said the government will score doctors on these quality measures against every other state.

“We have a population base that’s less healthy than the rest of the country. And I don’t think that’s a big secret,” Padgett said. “Some of the measurements Medicare will use could be based on national bench marks, and if they are, we could potentially be ranked lower, and therefore the providers get penalized.”

Health care providers next year will have to report this information and 50 percent of that bonus or penalty will based on the how well patients do. Another 25 percent will be based on the use of electronic health records, 15 percent on professional education courses and 10 percent on the cost of care.

Piggy Express: ‘Right To Farm’ Law Shields Giant Hog Operation Monday, Oct 17 2016 

Mount St. Joseph in Daviess County, Kentucky, may appear calm with the Green River flowing past homes that dot the farmland here. But there is trouble in the air and it comes along with the smell of a large hog farm.

Sixty-three year old Jerry O’Bryan was born and raised on a farm in Daviess County. By the time he was 22 he had lost both parents and was left 150 acres to support his family.

“Back when I started there was two things that a young man with very little money could do to get started in agriculture, one of them was tobacco and the other one was hogs,” explained O’Bryan.

Jerry O'Bryan's farm produces 200,000 market hogs a year.Nicole Erwin | Ohio Valley ReSource

Jerry O’Bryan’s farm produces 200,000 market hogs a year.

Now he produces more than 200,000 market hogs a year. Recently, he built a hog truck wash, Piggy Express LLC., to sanitize five semi-trucks used a day to transport hogs to market. The facility upset local residents. They’ve formed  a group called CAPPAD, or Community Against Pig Pollution and Disease. Don Peters, a retired engineer, is a member.

“This truck wash was built to counter the transmission of the PED virus, which is Porcine Epidemic Diarrhea. That wiped out about half of the western Kentucky pig herd here about two years ago,” Peters said.

Worried that polluted runoff from those trucks could reach other properties, some just 200 feet away, Peters is frustrated by what he sees as an abuse of a well-meaning law: the Right to Farm Law. He says O’Bryan shouldn’t have had the right to build the wash in the first place, but the dated language of the state’s Right to Farm law supported it by shielding the owner from legal challenge.

 "They do not have the right to change the face of agriculture,” O’Bryan said of his neighbors.Nicole Erwin | Ohio Valley ReSource

“They do not have the right to change the face of agriculture,” O’Bryan said of his neighbors.

Right To Farm, But Which Farms?

“We’re in total agreement with the Right to Farm Bill and its intended purpose,” Peters said. “But it has been hijacked and in this particular case being used as a screen to afford the particular operation to move into what would normally be considered a community,” said Peters.

Peters believes what’s happened in Daviess County could happen almost anywhere. Every state has some version of a Right to Farm statute and, like Kentucky, many have dated language.

“You have these houses here, you have these houses here, here," Peters said "He comes along and, plunk, right in the middle,” Nicole Erwin | Ohio Valley ReSource

“You have these houses here, you have these houses here, here,”Peters said “He comes along and, plunk, right in the middle,”

Rusty Rumley is a senior staff attorney at the National Agricultural Law Center. He says most statutes were implemented in the ‘70s and ‘80s to protect farmers from nuisance lawsuits long before the rise of many industrial-scale operations. [Story continues below graphic.]

right-to-farm-states-bills-v3Alexandra Kanik | Ohio Valley ReSource

“Most of the states there is no reference to the [farm] size. Some of them have been updated since then, but for the most part, many of those laws are substantially on the books now as they were when they were originally enacted,” said Rumley.

Kentucky’s statute overrules any local or county ordinances with farms in operation for more than a year. Ohio’s statute protects industry in any agricultural zoned area that is in devoted exclusively to agricultural production three of the five calendar years.

Missouri and North Dakota  have recently added the Right to Farm to their constitution, placing farming on par with speech and religion and guns. Oklahoma is attempting the same with  question 777 on on the ballot for November 8, which is completely different from the old version, according to Rumley.

“This new version” he said,  would give Oklahoma farms the constitutional right to raise livestock without interference from future regulations by the state Legislature without a compelling state interest.

“The older Right to Farm Bills,” like Kentucky’s Rumley said, “strictly offer nuisance protection.”  While they have the same title legislation varies greatly from state to state.

Rumely said as a general rule of thumb,  “the more important agriculture is to the economy of the state the stronger the right to farm protection will generally be.”

Kentucky’s Statute

Since a Right to Farm Bill was first passed in Kentucky in 1980, only once has a court publicly ruled on the statute. Jay Prather is a Lexington based lawyer that represented the plaintiff in Powell v Tosh, a case where a group of concerned citizens filed suit against a commercial hog operation. In the 2013 pretrial decision, the courts addressed the Right to Farm statute used as defense.

“The farm in question had only begun hog operations in the previous few years,” explained Prather. “All of the plaintiffs lived on their land before the hog operations began so the court ruled that the hog operation was not a pre-existing operation, even though the land had been used for farm land it had previously just been used to grow crops, and some small livestock, but not for industrial farming,” said Prather.

The Powell v Tosh case was a closed settlement and took place in district court, so Prather said it’s not binding on any future court decisions, but would certainly be persuasive.

Peters of CAPPAD hopes a lawmaker will amend Kentucky’s Right to Farm language to give existing communities protection as well as farms. But in an election year no one has offered to bring it to the legislature.

Kentucky Department of Agriculture Chief of Staff Keith Rogers said he has not been approached by CAPPAD on the issue but would be willing to sit down with the group, along with Agriculture Commissioner Ryan Quarles, to better understand the concerns.

If CAPPAD can not find a sponsor to amend the Kentucky Right to Farm statute, Rogers said “the KDA and Commissioner can propose legislation as needed to members of the general assembly.”

But changes in the law “sometimes takes years” Rogers said, because of the educational process and bringing a consensus together. Rogers believes the state will only hear more issues related to the statute.

“Agriculture has changed a great deal over the last 10 or 20 years and many of our farming operations have grown substantially,” Rogers said. “This may be one of those situations where it’s time to take a review of the Right to Farm Law.”

Rogers said the KDA will side with the farms as long as they are “good actors” or environmentally compliant.

‘Gray Water’ No Black and White Issue

“We're in total agreement with the Right to Farm Bill and its intended purpose,” Peters said. “But it has been hijacked in this particular case."Nicole Erwin | Ohio Valley ReSource

“We’re in total agreement with the Right to Farm Bill and its intended purpose,” Peters said. “But it has been hijacked in this particular case.”

Peters said the environmental compliance issue is his greatest concern. He stood on his neighbor’s property line taking in the nearby truck wash.

“You have these houses here, you have these houses here, here, here, here, here, you have our two houses, he comes along and, plunk, right in the middle,” he said. Peters points out while the area is agriculturally zoned, there is a community of residences that existed before this truck wash was conceived.

right-to-farm-mapAlexandra Kanik | Ohio Valley ReSource

Since the wash began operations in February, Peters said appraisals of nearby homes show they have lost 15 to 30 percent of their value.

Rachel Foster, a property valuation administrator for the area confirmed the loss. She said two of those homes have appealed further depreciation because they feel the appraisal should have demonstrated a greater loss in value.

More than property value, Peters  is concerned about the impoundment used to store waste water from the trucks. O’Bryan calls it a “gray water pond.” Peters says it’s a “lagoon.” It’s an important distinction  because Kentucky’s Division of Water doesn’t regulate gray water, but they do regulate lagoons associated with the pork industry.

O’Bryan calls the wastewater impoundment at the wash a “gray water pond” because he believes a lagoon is “something that is getting a lot of nutrient load and this is not.”

Peters is worried about how O’Bryan will control the waste water levels.

“So this field is to get rid of that water, and this stream is to get rid of that water,” Peter said, pointing to features nearby. “That’s the real reason he bought it.”

Jerry O’Bryan said he looked for more than a year before deciding where to put the truck wash, he said it had to be far enough from the hogs to maintain proper biosecurity measures.

“We had to find something far away and we found this place and everything about it seemed to fit, I gave a lot of money for it, it’s about 3 miles away from our nearest hogs,” O’Bryan said.

"Gray water pond" or "pig waste lagoon"? The answer may determine what rules apply.Nicole Erwin | Ohio Valley ReSource

“Gray water pond” or “pig waste lagoon”? The answer may determine what rules apply.

An Escalating Farm Fight

O’Bryan maintains that his operation is business as usual and that the CAPPAD members are trying to change something they just don’t understand. And he has some pretty inflammatory words for his neighbors.

“Now I could get real radical and belligerent and say well they remind me of Muslims they come in and they want to change the culture,” O’Bryan said. “These are obviously Americans but they do not have the right to change the face of agriculture,” said O’Bryan.

O’Bryan says he has seen this all before. CAPPAD will grow tired of complaining and it will all go away. But Don Peters insists he is here to stay.

“Let me put it this way,” Peters said. “I’m going to die here. So I’ll fight it. I don’t have that many more years left.”

New Kentucky Home: From Battle Zone Refugee To Business Owner Monday, Oct 3 2016 

The international refugee crisis caused by people fleeing the war-torn Middle East has been a high-profile issue in the presidential campaign.

Democratic nominee Hillary Clinton told CBS’s “Face the Nation” last year that “the U.S. has to do more” to meet what she called the worst refugee crisis since the end of WWII.

Republican opponent Donald Trump told a rally in New Hampshire that as president he would turn away refugees from nations such as Syria. “If I win, they’re going back!” he said.

But beyond the heated political rhetoric, the work of finding new homes for asylum seekers continues at a dozen refugee resettlement areas in Kentucky, Ohio, and West Virginia. And as new new refugees arrive from Syria, those who have already made the transition to a new life in America are lending a hand.

The International Center of Kentucky, in Bowling Green, will be resettling forty Syrian refugees this month. They’ll join a community of more than 10,000 asylum seekers from around the world that the center has helped to resettle since beginning operation in 1981.

I sat down with a former refugee to better understand his journey, and how the small business he has started is creating a community of support for refugees making their new Kentucky home.

From the Middle East to the Midwest

In 2013 Wisam Asal opened Jasmine International Grocery, a small family run store with sweets, religious items and food from many countries.

Asal's Jasmine International Grocery has become an important part of the community of refugees in Bowling Green. Becca Schimmel | Ohio Valley ReSource

Asal’s Jasmine International Grocery has become an important part of the community of refugees in Bowling Green.

Asal walks across the street wearing a baseball cap to his new restaurant, Babylon. People chat and catch up at the counter as they order shawarma and falafel sandwiches. He’s found a way to bring a bit of his home country’s culture to Kentucky and create two businesses that have quickly become important to Bowling Green’s international community.

Asal said it wasn’t easy starting a business here but the community of refugees and other people in Bowling Green helped him succeed.

“We have friends who are at the same time our customer,” Asal said. “They help us, they encourage us.”

Wisam Asal left his native Iraq as a refugee. Now he owns two small businesses in Bowling Green.Becca Schimmel | Ohio Valley ReSource

Wisam Asal left his native Iraq as a refugee. Now he owns two small businesses in Bowling Green.

Life During Wartime

In his native country, Iraq, Asal taught English until the U.S. war when he became a translator for the U.S. Army. The work made him and his family potential targets. Even his trips between home and work became hazardous, as kidnappers and assassins would strike translators or their loved ones during these daily routines.

“Some of my friends work as translator, interpreter has been killed or like kidnapped. Nobody has idea about them,” Asal said.

It took two years before Asal got approval to move to America through a refugee resettlement program. He packed up and moved to Bowling Green with his wife and two daughters in 2010. His son was born in 2011.

When Asal first got here there weren’t many jobs. So, like many other refugees, he worked in a chicken processing factory. He then worked as a teacher’s aide before deciding that he wanted to start his own business.

Love Of Food Becomes A Business

Asal saw a need for other refugees to get the Halal food that they were used to. Halal means food prepared in ways permissible under Islamic practices. Some were driving as far as Nashville to get Halal meats.

“They say they were suffering to get what they like or their kind of food,” Asal said.

Wisam Asal's Bowling Green restaurant, Babylon.Becca Schimmel | Ohio Valley ReSource

Wisam Asal’s Bowling Green restaurant, Babylon.

Asal and many other refugees get halal food for their home from the Amish community. The Amish keep knives in a separate area that are used specifically to prepare halal meat.

“Some of them they make private place for Muslim people,” he said. “Even the knives and things they tell us, ‘This is for you.’”

Asal said he realizes that many Americans might not understand the lengths he and other Muslim immigrants go to for properly prepared food. “It is religion, we have to,” he said. “It is not like something small you can give up.”

refugee-pop-ky-v2Alexandra Kanik | Ohio Valley ReSource
refugee-pop-oh-v2Alexandra Kanik | Ohio Valley ReSource
refugee-pop-wv-v2Alexandra Kanik | Ohio Valley ReSource

Asal has found food is an important part of culture and identity for new arrivals in the country. He says even many children of refugees who grow up in America still prefer to eat the way their parents do.

The grocery store isn’t just a place to buy food. It’s a place for people to keep in touch, find out whose family will be coming to America next, what events are being planned and what’s going on in the world. It’s also a place where newcomers come to get help.

“People keep coming to us asking for help, how to go to doctor, how to buy cars or things,” he said. “Even sometimes we close our business to go with them, because maybe they are refugee,” Asal said. His business has become much more.

“I call it, this is another international center. “

Bowling Green, pop. 61,400, has helped to resettle some 10,000 refugees in the past 35 years. Becca Schimmel | Ohio Valley ReSource

Bowling Green, pop. 61,400, has helped to resettle some 10,000 refugees in the past 35 years.

A Balance Of Cultures

As Asal explained his work and home life, it was clear he’s hoping to find a balance between assimilating in his new home and keeping in touch with his old one. He and his wife continue teaching their children Arabic in hopes it will help them maintain their culture. Although they prefer American cartoons, Asal encourages them to watch cartoons in Arabic.

“The TV has big effect on anyone. So we have our channels they can watch these channels and keep them learning Arabic and what is going on in our countries,” Asal said.

Some of his descriptions of parenting sound much like any other parent’s concerns. He worries that his children don’t get to roam free outside as much as they did before, when they had a large yard, and could play without being watched by their parents.

“When we grew up there it was safe for you to play outside because most people, they know each other. But here you can’t let them go out for long time, you have to watch them,” Asal said.

Although it’s different living in America Asal considers this home now and he says over time the differences between people have disappeared. He likes the people and the safety he has here.

“The people they are nice and when you ask them something they help you. They keep smiling,” Asal said.

Asal doesn’t feel homesick for his home in Iraq. Rather, when he goes back to visit he finds himself missing his home here in America.

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