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.

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.

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.

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