Saturday, August 19, 2017

Where does your county rank in painkiller prescriptions per person? Here are the numbers, and possible reasons for them

Kentucky Health News reported in July about a Centers for Disease Control and Prevention report showing ranges of painkillers sold per person in each county in 2015 and whether there had been an increase or decrease since 2010. At the time, the individual county data wasn't available, but now it is.

The CDC report calculated the rate of "morphine equivalent doses" sold at retail pharmacies in 2010 and 2015 in each county and whether there had been an increase or decrease, if the change was greater than or equal to 10 percent. Counties with changes of less than 10 percent were labeled "stable."

Morphine equivalent doses, in milligrams, are determined by a calculation that allows health-care providers to understand how potent one opioid is compared to another.

The report found that painkiller prescriptions had declined statewide, but increased or remained high in many counties from 2010 to 2015.

Opioid doses per person decreased in 71 counties, increased in 19, and were considered stable in 24. Six counties didn't have enough data to show a trend. The report does not account for people who fill their prescription in one county but live in another.

On the 2015 map, the counties are shaded by quartiles, each representing one-fourth of the total range. Here's a table of the top quartile, showing the 30 Kentucky counties with the most doses per person of opioid painkillers in 2015. Click here for a spreadsheet that gives figures for all counties.
Click here to download the full data set.
The report gives partial credit for the decline to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, which went from voluntary to mandatory during the period.

The report says, "The substantial variation in opioid prescribing observed at the county level suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use, and demonstrates the need for better application of guidance and standards around opioid prescribing practices."

It says counties with higher amounts of opioids tended to have "a larger percentage of non-Hispanic whites; higher rates of uninsured and Medicaid enrollment, lower educational attainment; higher rates of unemployment; micropolitan status [counties with towns of 10,000 to 50,000]; more dentists and physicians per capita; a higher prevalence of diagnosed diabetes, arthritis, and disability; and higher suicide rates."

The data for the study came from the Quintiles IMS Transactional Data Warehouse. It does not include prescriptions dispensed directly by prescribers.

Frankfort Independent Schools offer programs for students at risk of attempting suicide; experts offer guidance

Frankfort Independent Schools are working to prevent teen suicide, attempts of which are probably more common than most people think.

Austin Horn reports for The State Journal in Frankfort that a 2016 survey of Kentucky high-school sophomores found that 8.2 percent said they had attempted suicide, and the rate was 8.4 percent in the Bluegrass, where Frankfort is located. The national rate is 9.4 percent.

“It’s a very serious issue,” Dr. Julie Cerel, a psychologist and professor at the University of Kentucky College of Social Work and president of the American Association of Suicidology, told Horn.

School social worker Marci Fritts told Horn that she coordinates mental-health services for at-risk students at Second Street School and Frankfort High School through a partnership with the Kentucky Counseling Center.

“We have clinical therapists working with all of our identified students that (we identified) either through talking with parents, through collaboration with teachers, through referral in school, and approaching guardians and parents about services that potentially would benefit the student,” Fritts said. “We have two full-time therapists at Second Street School, and we have a therapist on-site at the high school.”

The school system also partners with Operation Making a Change, a program designed to provide young males with mentorship, and Fritts heads her own program called “My Life, My Choice,” a prevention-based program provided to all female sophomores at Frankfort High School.

Statewide, all middle and high-school students are required to receive some form of suicide prevention education by Sept. 1, and teachers are required to receive at least two hours of training. In addition, the state is also rolling out a “Sources of Strength” peer-led prevention program this year.

The biennial “Kentucky Incentives for Prevention” survey is given to students across the state in even-numbered grades starting in the sixth grade. It has only asked about suicide since 2014, when the suicide attempt rate for Kentucky's 10th-graders was 8 percent, compared to 8.6 percent nationwide. Suicide is the second leading cause of death among Kentucky's teens and young adults.

Cerel told Horn that there is never just one factor that leads a person to attempt suicide, but one study found that teens who had attempted suicide reported that the most common reason was a recent break-up, regardless of the length of the relationship. Cerel warned parents to take these break-ups seriously.

“If a teen is stressed or feels like something has happened and they’re never going to get over it, the adult response shouldn’t be, ‘Oh, that’s nothing, you’re going to grow up and find somebody else,’” Cerel told Horn. “The response probably should be, ‘I understand that this feels like the worst thing ever; let’s figure out a way to get you some help.’”

Dr. Vicki Hayes, a psychologist in Frankfort, told Horn that sometimes there are warning signs that shouldn't be ignored.

“One of the biggest behavioral things you want to watch for as a parent is abrupt change in a child’s behavior,” Hayes said. “Pay a lot of attention to that and try to find out what’s going on. If they’re saying anything morbid or that sounds suicidal, don’t let that ride. Don’t ever call a bluff or think that they don’t mean it. It’s better to err on the side of caution.”

Bullying is often cited as a reason for youth suicide attempts in Franklin County, Hayes told Horn.

“There are very few people who have not been bullied. I think there’s a huge bullying problem in Franklin County, and I’m concerned about it — all the schools,” Hayes said. “I don’t think any of them are doing enough to stop the bullying here in this particular county.”

In the 2015-16 school year, the Frankfort schools, with an enrollment of 735, reported 47 events of harassment, a rate of 6.4 percent, while the Franklin County Public Schools, with an enrollment of 6,131, reported 312, a 5 percent rate. The county system has two high schools, Franklin County and Western Hills. "The State Journal reached out multiple times to both Franklin County public high school psychologists but did not receive a response by press time," Horn reports.

Horn notes that the recent Netflix television series "13 Reasons Why," which depicts the aftermath of a fictional teenage girl's suicide, has also exposed teens to suicide and may have "adverse effects." This series has prompted schools throughout the state to send resource letters home with guidance on how to talk to children about suicide and has also warned that "vulnerable youth" should not watch it.

"Cerel referenced a recent study that showed Google searches for suicide methods increased by as much as 28 percent in the two weeks following the release of “13 Reasons Why," Horn reports.

Friday, August 18, 2017

Trump administration wants to drop Obama rule, tied up in court, that would ban binding arbitration in nursing-home disputes

"The Trump administration is pushing to scrap a rule that would have made it easier for nursing home residents to sue nursing homes for injuries caused by substandard care, abuse or neglect," reports Robert Pear of The New York Times. "The push would undo a rule issued by the Obama administration that would have prevented nursing homes from requiring that consumers agree to resolve any disputes through arbitration rather than litigation. Nursing homes routinely require consumers to sign an arbitration agreement as a condition of admission to the home."

Many businesses are including binding-arbitration rules in their contracts with consumers, Pear notes, but nursing homes are a special kind of business, dominated by a special kind of patient. "About half of nursing home residents have Alzheimer’s disease or other dementia, according to the National Center for Health Statistics, and consumer advocates say harried family members could easily miss the arbitration clauses as they move a loved one into a home offering care," he reports.

The rules were issued in September 2016, but a lawsuit by the industry and a judge's ruling kept them from taking effect.

The Obama administration said it was “almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen,” but the Trump administration makes another argument: “We believe that arbitration agreements are, in fact, advantageous to both providers and beneficiaries because they allow for the expeditious resolution of claims without the costs and expense of litigation.”

Trump-appointed officials at the Centers for Medicare and Medicaid Services have "proposed several requirements to protect nursing home residents who agree to binding arbitration," Pear reports, including “plain language” in contracts and an explanation to the consumer “in a form and manner that he or she understands.” The nursing-home industry has objected, calling the rules “hopelessly vague.”

State health department offers safety tips for Aug. 21 solar eclipse; cautions to not look directly at it without eye protection

In an eclipse, the moon shadows part of Earth.
The Kentucky Department of Public Health is warning the public to not look directly at the solar eclipse without proper eye protection.

“Looking at an eclipse without proper eye protection can cause permanent and irreversible eye damage, including blindness” Health Commissioner Hiram C. Polk Jr. said in a news release. “We encourage everyone to enjoy this special celestial event, but urge the public not to look directly at the uneclipsed or partially eclipsed sun without special-purpose solar filters such as eclipse glasses or handheld solar viewers.”

This long awaited celestial event Polk is talking about will happen Monday, Aug 21. While Hopkinsville, Paducah and the Land between the Lakes are in the 70-mile path of totality, all of Kentucky will be able to see a "deep partial eclipse." Totality will last less than three minutes, but the sun will be partially obscured for more than two hours. Online interactive maps and guides give the times; one is

State officials offers tips on how to safely view a solar eclipse and avoid permanent eye damage:
  • Only use eclipse glasses or handheld solar viewers that meet the International Organization for Standardization international standards.
  • Homemade filters or ordinary sunglasses, even very dark ones, are not safe for looking at the sun.
  • Telescopes with solar filters on the large end can be used, but older telescopes that have small solar filters that attach to the eyepiece are not safe.
  • It is safe to use pinhole projectors and other projection techniques that offer indirect viewing of the eclipse. These can be made with paper or cardstock.
  • Do not look at the eclipse through an unfiltered camera, telescope, binoculars or other optical device.
  • Do not look at the sun through a camera, telescope, binoculars or any other optical device while using your eclipses glasses or handheld solar viewer. The concentrated solar rays will damage the filter and enter your eye(s), causing serious injury.
  • Seek expert advice before using a solar filter with a camera, telescope, binoculars or any other optical device.

The state health department also offers safety tips for those who will be spending the day outdoors while waiting on the eclipse, including: stay hydrated and drink plenty of water; avoid drinking alcohol, which causes you to lose fluid; wear light colored, loose fitting clothes and a hat; apply and reapply sunscreen throughout the day with at at least a SPF 15 rating; use an Environmental Protection Agency-registered insect repellent, and keep your hands washed to avoid spreading germs.

State health officials will deploy portable medical tents at an upcoming eclipse event in Hopkinsville and all food vendors in the region will be inspected, says the release.

Click here for a link to the state released video about eclipse eye safety. Click here for one directed toward children.

Health foundation offers workshop to help businesses implement smoke-free policies; smokers cost businesses extra $5,800/year

The Foundation for a Healthy Kentucky is offering a workshop to help businesses learn how to implement smoke-free policies in their workplaces Aug. 31 in Louisville.

"More than 70 percent of Kentucky adults and 90 percent of Kentucky businesses support smoke-free, so it's never been easier for Kentucky businesses to adopt workplace policies to protect their employees from the dangers of secondhand smoke," Ben Chandler, president and CEO of the foundation, said in a news release.

The 75-minute workshop will be part of the Kentucky Society for Human Resource Management conference Aug. 29-31 at the Galt House in Louisville. It will be led by University of Kentucky Associate Professor Melinda Ickes, who is also a faculty associate with the Kentucky Center for Smoke-free Policy. The presentation will be Thursday, Aug. 31 at 10:30 a.m. Click here to register.

"Smoking costs businesses an estimated $5,800 per smoker in extra expenditures each year, including productivity losses and additional health care costs, and puts them at risk for the health consequences for all workers exposed to secondhand smoke," says the release.

The foundation will also offer information about developing and implementing smoke-free workplace policies at its exhibit booth at the conference and on its website afterward.

Thursday, August 17, 2017

National panel studying surface coal mining's effects on health sets meetings Mon. night in Hazard, Tue. afternoon in Lexington

In a study of possible health risks from large-scale strip mining, the National Academies of Sciences, Engineering and Medicine will hold two public meetings in Kentucky.

The first meeting will be held from 6:30 to 9 p.m. Monday, Aug. 21, at the Perry County Library, 289 Black Gold Blvd. in Hazard.

The second meeting will be held from 12:45 to 5 p.m. Tuesday at the Marriott Griffin Gate Resort, 1800 Newtown Pike in Lexington.

The study was commissioned by the Interior Department's Office of Surface Mining Reclamation and Enforcement, citing a “growing amount of academic research that relates to possible correlations between increased health risks as a result of living near surface coal mine operations.”

Bill Estep of the Lexington Herald-Leader notes, "Several studies have concluded that mountaintop mining in Central Appalachia is associated with higher rates of cancer, heart disease and other health problems among local residents." The leading researcher has pointed to dust containing rare-earth metals as a likely cause. However, a 2012 study by a Yale University researcher and others for coal interests "did not find that mining or mining-related pollution directly contributed to health problems in Central Appalachia," Estep notes. "Rather, the results pointed to 'substantial economic and cultural disadvantages that adversely impact the health of many area residents,' the study said." The leading researcher says his work has accounted for those issues.

Information about the study can be found here. For more information, or to register to attend, email or call 202-334-2766.

Cabinet for Health and Family Services promotes health and wellness at state fair, and collects duffel bags for foster kids
The Kentucky State Fair is not just a great place to support Kentucky's agriculture or to spend the day on the midway; it's also a great place to learn about some of the state's health and wellness initiatives and to donate a new duffel bag or backpack to a foster child.

“Often times, when children are removed from their home and placed into state care, all their belongings are literally stuffed into a black garbage bag,” Health Secretary Vickie Yates Brown Glisson said in a news release. "This effort changes that. Donating a duffel bag or backpack is a small but meaningful way to help foster children and give them the dignity of carrying their possessions in a new bag that is all their own.”

New duffel bags and backpacks will be collected at the Cabinet for Health and Family Services' exhibit in the Health Horizons area of the South Wing B. The fair runs through Aug. 27 at the Kentucky Exposition Center in Louisville.

The cabinet's exhibit will offer daily interactive displays that features learning activities for children and adults, free health screenings and on-site health educators who can speak to individuals about wellness and prevention. It will also offer free dental screenings for children with signed consents who are entering public school kindergarten or first grade from 10 a.m. to 2 p.m. daily.

In addition to these daily health initiatives, they will also have special "focus days," including:
  • Tuesday, Aug. 22: Services for Seniors, including Adult Protective Services, Aging and Independent Living/Long Term Care Ombudsman, and the Kentucky Prescription Assistance Program
  • Wednesday, Aug. 23: Focus on Foster Care and Adoption, 10 a.m. to noon
  • Thursday, Aug. 24: Focus on Zika Education and Mosquito Control, 10 a.m. to noon
  • Friday, Aug. 25: Focus on Substance Use Disorder Strategies and Services, 10 a.m. to noon
Exhibit buildings are open daily from 9 a.m. to 9 p.m. Sunday through Thursday and until 10 p.m. Friday and Saturday. Admission at the gate is $10 for adults, seniors and children; free for children 5 years and under. Parking at the gate is $10 per car.

Wednesday, August 16, 2017

Foundation for a Healthy Kentucky calls for statewide smoking ban, pushing people to quit by raising tobacco tax $1 a pack

Ben Chandler
Kentucky's poor health is hurting its economy, and the state needs a smoking ban and a big increase in its cigarette tax to prevent disease, Foundation for a Healthy Kentucky President Ben Chandler told a legislative committee Wednesday.

"The poor health of the commonwealth is one of the main things that's holding our economy back," Chandler said, telling the Interim Joint Committee on Health and Welfare that among the 50 states, Kentucky's population is 26th but its economy is 45th.

"The single most effective policy changes we can make to improve the health of Kentuckians are changes that will reduce our smoking rates and exposure to secondhand smoke," Chandler said. "Passing smoke-free laws and raising the tobacco tax by $1 or more per pack will help reduce smoking, save health care costs, and won't cost the state a dime."

Kentucky has a relatively low cigarette tax, 60 cents a pack, and the highest smoking rate in the nation, 26 percent of adults, as well as the highest death rate from cancer. "If there's anything that needs dealing with, it's that," Chandler said. "Doing something about this smoking problem is absolutely critical to the future of this state . . . . Businesses are not going to locate here if they don't have a healthy workforce."

Republican Sen. Tom Buford of Nicholasville called for a larger increase than Chandler, "Even to a $1.60 a pack is probably not going to provide us the result that we would like to have," Buford said. But he added, "I don't know if the will is there." Alluding to the late-January filing deadline for legislative elections, he said, "I can tell you February the first if there's a chance for tax reform."

Critics of a tobacco-tax increase have said it would penalize lower-income people, who are more likely to smoke. Chandler told the House-Senate committee that a big increase is needed to push them into quitting.

"You have to raise the tax by $1 or more to get the health benefits," he said. "Otherwise, it's just an added tax burden on the poor." He said cigarette companies would counter an increase of 30 to 40 cents a pack with discount coupons.

Asked where he would spend the money, Chandler, a former congressman and state attorney general, said some should be spent to discourage Kentuckians from smoking.

"We have a very good, in many respects, health-care system, but it's a rescue system," he said. "And people don't want to talk about this, but . . . we spend money largely, for the most part, on health care, to rescue people who are already sick. And we ought to spend a bigger portion . . . on health, as opposed to health care."

Referring to a smoking ban, which she supports, Sen. Julie Raque Adams of Louisville, the committee co-chair, said, "It's not really a freedom issue because every one of us pays out of pocket for those costs."

Chandler told the committee, "We have to focus on promoting policy changes that lead to healthier outcomes by addressing the things that cause poor health in the first place. . . . now have a rescue system."

Appalachian Kentucky continues to be the least healthy region of the state, and the disparity is increasing, Chandler said.

"While all of Kentucky lags behind the nation as a whole, it's generally people living in more rural Eastern counties with more challenging health issues," he said. "The latest numbers show that the health disparities between Central Appalachia and the rest of the nation, or even the rest of Appalachia, are large. And they're continuing to grow."

For example, he said the national death rate from heart disease "declined nearly 58 percent from 1980 to 2014, but not in Eastern Kentucky. In Owsley County, cardiovascular disease mortality actually increased over that 34-year period."

Another big Kentucky health problem is obesity. Chandler said, "Some of the evidence-based programs that help reduce obesity include making the healthy choice the easiest choice by replacing sugary drinks and snacks in school and government vending machines with healthier options, such as fruit and water; increasing the tax on sugary drinks; passing policies that require new streets to be walkable and bikeable; building sidewalks, walking trails, playgrounds and other places where residents can safely engage in physical activity; and adopting policies that enable farmers' markets to thrive."

A video of Chandler's testimony is on the KET website.

Tuesday, August 15, 2017

Scenario for reviving Obamacare repeal: Name Manchin to head Energy Dept. and replace him with a Republican senator

Senate Majority Leader Mitch McConnell could get the 50th vote he needs to pass an Obamacare repeal bill through a political shuffle by President Trump, who has been sniping at McConnell about failure to pass one.

It would work this way: Trump would name Energy Secretary Rick Perry secretary of homeland security, replacing Gen. John Kelly, who recently became Trump's chief of staff. Then Trump would name Democratic Sen. Joe Manchin of West Virginia energy secretary, and GOP Gov. Jim Justice would appoint a Republican to fill Manchin's unexpired term.

"Some congressional Democrats think it's possible, even likely," reports Harris Meyer of Modern Healthcare. "If the 49 GOP senators who voted for McConnell's stripped-down repeal bill last month backed the new legislation, the McConnell wouldn't need the votes of the three Republicans—Susan Collins, Lisa Murkowski and John McCain—who voted no last time."

"Rep. Karen Bass (D-Calif.) said Monday morning at a health-care town hall in Chicago that she and other Democrats expect Manchin will be offered the job and he will accept it," Meyer reports. "Then, they expect McConnell to quickly launch a new drive to pass a repeal-and-replace bill. That's what Trump has been needling McConnell to do since the previous bill failed by one vote on July 28, when McCain dramatically turned his thumb down."

There is also the possibility that McCain could resign from the Senate if his brain cancer progresses, Christopher Condeluci, a health-care lobbyist and former Senate Republican staffer, told Meyer. Arizona also has a Republican governor.

"Ron Pollack, chairman-emeritus of Families USA, who helped build grassroots support for ACA's passage in 2010, said he is skeptical about the Manchin replacement scenario, but he cautioned that ACA supporters should remain vigilant," Meyer reports. "Even if Republicans succeed in executing this personnel switcheroo, McConnell wouldn't necessarily have 50 votes he needs to pass either the so-called skinny repeal bill or a broader repeal-and-replace package."

Tom Miller, a conservative health policy analyst at the American Enterprise Institute, told Meyer, "The next hurdle is finding 50 real votes for skinny repeal when McCain isn't available to bail out up to a half-dozen or more Republican senators who voted for it very reluctantly last time."

The Hill notes, "Manchin was reportedly considered for the job after Trump's election in November." Manchin, who faces a potentially tough re-election battle in 2018, represents a state that has swung sharply Republican, largely because of troubles of its signature industry, coal, during the Obama administration.

Monday, August 14, 2017

Trump doesn't want to compromise or 'move on' from health bill, as McConnell called for, but aides disagree, Politico reports

"There's a divide between the president, who doesn't want to compromise or move on, and officials who would quietly prefer to leave health care alone after a bruising fight that climaxed in Trump's public clashes" with Senate Majority Leader Mitch McConnell, Josh Dawsey of Politico reports.

Sunday, August 13, 2017

Health secretary says 'No one is going to be pushed off Medicaid,' but plan says fewer will have it, and has pitfalls to lose coverage

Health Secretary Vickie Yates Brown Glisson on KET
By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin's proposal to overhaul the state's Medicaid program, with its latest modifications, says it would leave 95,000 fewer Kentuckians on Medicaid in five years than there would be otherwise.

Exactly what that means depends on whom you ask.

"No one is going to be pushed off of Medicaid, no one is losing their benefits," Health Secretary Vickie Yates Brown Glisson told Renee Shaw on KET's "Connections with Renee Shaw."

Glisson's comment prompted a Twitter storm from Dustin Pugel, a research and policy associate for the liberal-leaning Kentucky Center for Economic Policy: "What happens when someone fails to report that they got a couple extra shifts, or their tips lowered their wages? . . . What happens if someone fails to make their $1-$37.50 monthly premium one month? . . . What happens if someone works 19 hours one week instead of 20 and can't find an extra hour of qualifying volunteer work? . . . What happens if someone loses track and doesn't re-enroll at the end of a year's coverage? Kicked off."

Asked to clarify Glisson's comment, Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail: "Kentucky HEALTH does not change income eligibility thresholds. People who participate in the program will have access to the same health coverage and benefits they have today." He added, "There will be no changes in benefits for certain low-income adults, caregivers, children, pregnant women, the elderly, and those with disabilities."

Pugel said in an interview, "If you add these new requirements that people can't meet, those requirements are responsible for people losing coverage." He added, "Indiana’s requested work requirement is very similar to ours, and it states that a quarter of the people who must comply with a work requirement will lose coverage because they are unable to meet it. Also in Indiana, the premiums they charge led to tens of thousands either losing coverage or never getting coverage to begin with because people didn’t pay them."

Glisson said on KET that with the help of a "continuum of services" to be offered in the new Medicaid plan, called Kentucky HEALTH, able-bodied adults without dependents who are on Medicaid will eventually transition to better paying jobs that offer employer health insurance.

"We need to connect you with the jobs, we need to get you the training for those jobs. And if you chose to, we're hoping that you're going to be able to transition to an employer-sponsored insurance product," Glisson said.

In the separate interview, Pugel argued that the high-paying jobs with health benefits that the Bevin administration expects these able-bodied adults to move to simply don't exist in Kentucky.

He said many Kentucky counties have fewer jobs than they did before the recession, and the handful of counties that have seen some job growth are seeing it in temporary-agency work, which he said "nearly never" offers benefits like health insurance.

"There are a lot of folks who live in areas where there just aren't jobs, let alone the kind of jobs that would offer the kind of benefits she is talking about, Pugel said.

He added that employers don't offer health insurance as a benefit nearly as much as they used to, especially in the kinds of jobs held by people who earn near the Medicaid income limit, $16,400 for an individual. He said the share of Kentucky workers who received insurance through their employer has fallen from 70 percent in 1980-82 to 53.7 percent in 2011-2013. The Kaiser Family Foundation reported that only 47.8 percent of private sector firms in Kentucky offer health insurance in 2015.

"These folks work in jobs like construction and child care and restaurants. These are not jobs where employers offer coverage, or coverage that these folks can afford," Pugel said. "Medicaid fills a role. It really does for working Kentuckians."

Kentucky submitted its proposal to overhaul the state's Medicaid program to the federal Centers for Medicare and Medicaid Services about 11 months ago. Glisson told Shaw that the state expects to submit its final version in mid- to late August.

The proposal, which is expected to be approved, focuses on "able-bodied" adults without dependents who qualify for Medicaid under the expansion of the program to those who earn 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act.

Kentucky has 1.4 million people on Medicaid, with around 470,000 of them covered under the expansion. Bevin has said the state can't afford to pay for this expanded population (the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020) .

The new plan is designed to not only save Kentucky money, but to also encourage participants to have some "skin in the game" through premiums and work or community engagement requirements that encourage people to have a higher level of involvement in their care.

The state proposed modifications to the original proposal in July. Glisson called the changes that strengthened the work and community engagement requirements and added a six-month lock-out period for those who fail to report changes in their work and employment status within 10 days of the change, "fairly minor."

To this, Pugel tweeted, "The 'minor changes' she's referring to kicks an extra 9,050 people off Medicaid and reduces spending by tens of million." Actually, the "kicked off" number is the difference between the number who are expected to be on the program in five years and the number expected to be on it if no changes are made.

More than 1,000 Kentuckians submitted comments about the added changes to the proposal, and almost all of them opposed it.

Saturday, August 12, 2017

Kentucky newspapers showed much more interest this year in the County Health Rankings, no matter if they were good or bad

By Elizabeth Spencer and Al Cross
Institute for Rural Journalism and Community Issues
University of Kentucky School of Journalism and Media

More Kentucky newspapers are writing about their communities' health, even when it presents an unfavorable picture, when measured by coverage of the annual County Health Rankings.

Kentucky papers reported on the rankings at a record rate in 2017, according to an analysis by researchers at the University of Kentucky's Institute for Rural Journalism and Community Issues.

The researchers examined 106 of the approximately 140 paid-circulation newspapers outside Kentucky's three major urban areas, covering 115 of the state's 120 counties. They found that 31 papers in 30 counties published 36 separate articles about the rankings in the five weeks after the rankings were released in late March. That was many more than in previous years.

Williamsburg Mayor Roddy Harrison led a one-mile walk to
promote health. (Photo: Corbin Times-Tribune, Angela Turner)
Not only did more papers report the rankings, there was no discernible difference in the likelihood of publication in healthier or unhealthier counties, unlike most previous years.

In the first few years of the rankings, residents of highly ranked Kentucky counties were much more likely to read that news in their local paper, while such stories in poorly ranked counties were scarce.

That pattern disappeared two years ago, but recurred in 2016, when relatively few Kentucky papers published stories about the rankings. This year, with a much larger sample, there was a strikingly even distribution of stories, with as many in poorly ranked counties as highly ranked ones.

That indicates that newspapers in lower-ranked counties have seen a need to inform citizens about their communities' lower health status, and to at least implicitly suggest a need for their readers to consider their health behaviors.

The County Health Rankings and Roadmaps is a program at the University of Wisconsin Population Health Institute and funded by the Robert Wood Johnson Foundation. The rankings are based on health outcomes, such as statistics on disease and death; factors that affect health, such as health behaviors like smoking, as well as social and economic factors; and local policies and programs, such as clinical care and the physical environment.

The rankings compare counties within each state, not nationwide. Communities can use the comparisons to identify problems that individuals, community organizations and local leaders need to address.

Research details

The main source for the latest research was the archive of printed Kentucky newspapers at the University of Kentucky. Papers unavailable in the archive were searched online. Not all Kentucky papers could be searched, because some newspapers do not have websites. Not all the published articles may have been found, because some papers that have websites do not place news articles there, and some that do greatly limit their online publication of stories that are not locally generated.

Because the Institute for Rural Journalism focuses on rural news media, the study did not include newspapers in Kentucky's five most urban counties: Jefferson, Fayette, Kenton, Campbell and Boone.

Researchers found 36 County Health Rankings articles in 31 newspapers. In one county, two papers had a CHR story. In three counties, the newspaper published more than one story, including an editorial in The News-Enterprise of Elizabethtown.

The Corbin Times-Tribune, which covers Whitley and Knox counties and part of southern Laurel County, did a three-part series on the rankings, one of which promoted a community walk held by the Whitley County Health Department. The county ranked 107th in health outcomes and 87th in health factors. Knox County ranked 102nd and 115th, respectively.

Analysis of the coverage included whether or not the paper framed the story with a county-specific localization of the data. Of the total sample, 89 percent included some form of localization, but two of those stories were localized only by the headline. Thirty-one percent of the stories included a comment from a local authority on health factors and outcomes. Only 11 percent quoted a community member.

Newspaper staff members wrote 69 percent of the stories. One-fourth of the coverage used the Kentucky Health News story, which focused on the rise in Kentucky's premature death rate. KHN is an independent news service of the Institute for Rural Journalism, funded by the Foundation for a Healthy Kentucky.

Overall, 34 percent of the sampled papers published a story about the County Health Rankings. The publication frequency for 2016 rate was only 7.6 percent.

In 2015, the publication rate was 24.53 percent, and in 2014, it was 18.52 percent. In those years, Rural Journalism researchers examined one-third of all papers in the state, drawing a random sample from those available in the printed archive.

The research also examined whether the stories described the rankings and the county's health status in a positive or negative light. Not surprisingly, 16 had a positive framing, 16 had a negative framing, and 11 percent (four) of the stories offered a more balanced perspective. While some stories reflected celebration of an improved ranking, there are still serious health issues in every county.

Because the differences among closely ranked counties are small, maps with the rankings separate them into quartiles, or fourths. An online interactive map gives the individual rankings, and clicking on a county gives a detailed breakdown of the factors contributing to the rankings, as well as its recent trend.