Feds want to know what you think about Bevin plan to overhaul Medicaid & Kentucky makes Medicaid copays mandatory ‘under the cover of darkness’

Feds want to know what you think about Bevin plan to overhaul Medicaid

Deborah Yetter, Louisville Courier Journal Published 3:05 p.m. ET July 20, 2018

The federal government, once again, wants to know what people think about Gov. Matt Bevin’s plan to overhaul Kentucky’s Medicaid.

Less than a month after a federal judge struck down Bevin’s plan that includes work requirements and premiums for some Kentuckians who get health coverage through Medicaid, the U.S. Centers for Medicare and Medicaid Services (CMS) is seeking public comments on the exact same plan, known as a “waiver.”

The public comment period began July 19 and ends Aug. 18.

Health advocates who are concerned about the changes say it’s important that people take advantage of the public comment period, as they did last year when CMS previously reviewed Bevin’s plan before approving it in January.

“It really matters that people speak up,” said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of organizations. “This is the exact same waiver.”

During the previous public comment period, about 3,000 people responded, the majority opposed to the waiver, Beauregard said.

Read more: Bevin official rips Democrats, Courier Journal over his dental care cuts

It’s not clear why CMS is seeking comments on the same plan that was rejected June 29 by U.S. District Judge James Boasberg, of Washington D.C. The judge vacated CMS’ previous approval of the plan and sent it back to the agency for further review, finding among deficiencies that the agency did not fully consider previous public comments.

A CMS statement said the agency is seeking more comments “to ensure that interested stakeholders have an opportunity to comment on issues raised in the litigation and the court’s decision.”

Some health advocates have speculated it’s part of an effort by the Trump administration to push through work requirements for people enrolled in Medicaid, following public comments by CMS administrator Seema Verma at a July 17 Politico event.

“We are very committed to this,” Verma said, according to Politico. “We are looking at what the court said. We want to be respectful of the court’s decision while also wanting to push ahead with our policy initiatives and our goals. … We are trying to figure out a path forward.”

Adam Meier, secretary of the Cabinet for Health and Family Services, told a legislative committee Wednesday that Kentucky Medicaid officials are working with CMS to enact the plan.

“Our position is that we’d like to gain re-approval as quickly as possible,” he said.

Health law advocates who successfully challenged Kentucky’s plan in federal court said they intend to argue that, as the judge found, the plan does not conform with the federal Medicaid law, which is to improve access to  health care for vulnerable citizens.

Medicaid is a federal state health plan for low-income and disabled individuals.

“We continue to take the position that work requirements are illegal because they are inconsistent with the Medicaid Act,” said Jane Perkins, legal director of the National Health Law Program in Washington.  “We will certainly be commenting during this re-opened period.”

Perkins’ group has posted additional information about the importance of public comments on its website, www.healthlaw.org.

Kentucky was the first state to win CMS approval of Medicaid work requirements.

They have already been approved in Arkansas, Indiana and New Hampshire, while Arizona, Maine, Wisconsin and Utah are waiting to hear from CMS, Politico reported.

Under Bevin’s plan, “able-bodied adults” among the about a half-million people added to Medicaid under the Affordable Care Act would be subject to “community engagement” requirements that they work or volunteer at least 20 hours a week. They also would pay premiums of $1 to $15 per month and could be subject to a “lock-out” of coverage up to six months for failing to meet requirements.

Basic vision and dental benefits would be eliminated for that group though they could earn points to purchase such services through a “My Rewards” account through activities such as volunteering or taking online self-improvement classes.

Kentucky officials said in a statement Thursday that the Cabinet for Health and Family Services has “been working with CMS on details of the re-approval process, including the status of dental and vision benefits.”

The abrupt decision of the Bevin administration to cut dental, vision and non-emergency transportation benefits July 1, two days after the judge rejected the plan, sparked an uproar among patients and health care providers across Kentucky.

On Thursday, the state announced it was reinstating the benefits while it works toward federal approval of its plan.

Here is a link to the public comment page on the CMS website: https://public.medicaid.gov/connect.ti/public.comments/viewQuestionnaire?qid=1897699.

Beauregard said Kentucky Voices for Health will also begin collecting comments on its website, https://www.kyvoicesforhealth.org/, starting July 23 that it will forward to state and federal officials.

Deborah Yetter: 502-582-4228; dyetter@courierjournal.com; Twitter: @d_yetter. Support strong local journalism by subscribing today: courier-journal.com/deborahy.

CONTINUE READING…

Kentucky makes Medicaid copays mandatory ‘under the cover of darkness’

Deborah Yetter, Louisville Courier Journal Published 1:43 p.m. ET July 27, 2018 | Updated 1:48 p.m. ET July 27, 2018

After three weeks of turmoil in Kentucky’s Medicaid program, a new complication — the state’s abrupt enactment of copays ranging from $1 to $50 for medical services — has triggered more confusion among patients, some afraid they can’t afford items such as essential medication for diabetes and asthma.

“It seemed to have been slipped in under the cover of darkness,” said Bill Wagner, CEO of Family Health Centers, a network of community clinics in Louisville. “Even though this went into effect July 1, the instructions have not come out.”

At the University of Louisville medical school, Dr. Barbara Casper, an internist, worries state officials didn’t consider the impact of the new copays on the very poor patients she treats in an outpatient clinic, many of them seriously ill.

“Some of our patients can’t even pay $1,” said Casper, who credits Kentucky’s 2014 expansion of Medicaid under the Affordable Care Act for providing health coverage for many of the low-income patients U of L sees at its clinics.

“This was a problem before we had the Medicaid expansion,” she said. “We had a $2 copay for our patients to be seen and some of them couldn’t even come up with that.”

The clinic does not turn away patients who can’t pay, she said.

Related: Feds want to know what you think about Bevin plan to overhaul Medicaid

While small copays have long been allowed by Medicaid, Kentucky hasn’t required them in recent years. The sudden announcement that copays were mandatory July 1 caught many health providers and advocates off guard.

“Complete confusion,” is how Sheila Schuster, a longtime mental health advocate described it. “It’s not entirely clear what copays are charged for certain services.”

Adam Meier, secretary of the Cabinet for Health and Family Services, speaking at a legislative committee meeting July 18, said his agency is “still clarifying” some aspects of the copays. The cabinet did not respond to a request for information for this story.

Health providers say they aren’t sure who has to pay, who is exempt, how to collect the copays and what to do when patients can’t pay.

For example, pregnant women and children generally have been exempt from such requirements. But several health providers say it appears that children covered through Children’s Health Insurance Program, a Medicaid program for children of low-income parents, must now pay copays.

In Kentucky, about 90,000 children are covered by CHIP.

Background: Bevin will reverse cuts to Medicaid dental, vision services, state says

Some health providers are reassuring patients they will still get care if they can’t pay, including Bridgehaven, a day program in Louisville for people with serious, disabling mental illnesses.

“I worry about it causing them additional stress and anxiety when they’re already trying to cope with mental illness and trying to live on an extremely limited income,” Bridgehaven CEO Ramona Johnson said.

The copays come in the midst of upheaval in the Kentucky Medicaid program, which covers about 1.4 million people, including more than 600,000 children.

The state launched the copays on the same day it had planned to launch Gov. Matt Bevin’s sweeping plan to overhaul Medicaid, adding work requirements, premiums and other new rules aimed at “able-bodied” adults.

But a federal judge struck down the plan June 29, forcing the state to abruptly halt the changes that could affect nearly half a million Kentuckians.

Meanwhile, in a separate move effective July 1, the Bevin administration abruptly announced it had eliminated basic dental and vision coverage for up to 460,000 Kentuckians, creating an uproar particularly among patients who arrived at dentists’ offices only to discover they had no Medicaid coverage.

The administration quickly backtracked and on July 19 said it was rescinding the cuts to dental and vision benefits for now.

But the copays remain in place, leaving bewildered health providers trying to figure out with little guidance how to apply them. If the patient can’t pay, it comes out of the Medicaid reimbursement and the provider takes the loss.

“It could become a big issue for providers that operate with a very slim margin,” Johnson said.

Read this: ‘I want to have my teeth’: Bevin’s Medicaid cuts leave Kentuckians in pain

She said that includes her organization, Bridgehaven, whose clients typically visit the center three times a week and may receive three or more services per day, such as a visit with a therapist, a support group and a peer counseling session.

The state says providers must charge $3 per office visit for a service, so that means clients could end up owing $9 a day, Johnson said.

“Three times a day, three times a week, that’s $27 a week,” Johnson said. In addition, Bridgehaven clients will have to pay $3 for visits to a primary care physician or psychiatrist and copays for medication of up to $8 per prescription — medication she said is essential for people with mental illness to remain stable.

“Of course they don’t have that kind of money,” she said. “They struggle to pay their rent, their utilities, buy their groceries.”

Johnson said Bridgehaven will still provide services for clients for now regardless of ability to pay the copay, but the organization could lose up to $100,000 a year from an already tight budget by doing so.

She’s also worried copays will discourage people from seeking treatment.

And in the mental health area, if people don’t get regular services, they wind up homeless, in jail or in far more costly psychiatric hospitals — at state expense, according to mental health advocates.

Casper, the U of L physician, said that also holds true for patients she sees with serious conditions including diabetes, high blood pressure, congestive heart failure, asthma and emphysema.

She worries the patients will wind up in the emergency room or hospital if they skip office visits or cut back on medication because they can’t afford a copay. Copays for Medicaid range from $1 for generics to $4 or $8 for some name brand drugs.

Watch: ‘It’s just wrong:’ Susan Wells talks about how Medicaid cuts affected her

And while physicians try to prescribe generic drugs, some medications — such as insulin for diabetes and inhalers for asthma or other breathing disorders — mostly are available only as name brand drugs, she said.

“It’s not uncommon for some of our patients to be on 10 different medications,” Casper said. “They’re going to be back in the circumstances they were in previously. Do they eat, pay rent, their electric bill, take care of children or get their medicine?”

Casper said the new copays are especially frustrating because they come as patients now receiving regular care through Medicaid are beginning to make important changes in their lifestyles, losing weight, monitoring blood pressure and getting treatment for chronic illnesses.

“It kind of breaks my heart,” she said. “I’ve seen a lot more engagement in their health care by our patients. They’re doing all we want them to to stay healthy.”

Health providers said they are trying to explain the changes to patients and let them know what to expect but are having a hard time doing so absent clear guidance from state Medicaid officials.

“There’s no rhyme or reason as to how co-pays are coming through,” said Michael Lin, pharmacy director for Family Health Centers. “They’re so inconsistent.”

The state has sent out information to people on Medicaid but several providers say patients have brought it to them, unable to understand the complicated, bureaucratic language.

At the Family Health Centers pharmacy in Portland, patients are worried about whether they can afford new Medicaid copays, especially if they have multiple prescriptions for essential medications such as inhalers for asthma or insulin for diabetes.

“They worry about what’s going to happen if they don’t have the money,” Lin said.

The latest: Bevin shrugs off questions about his plans, draws comparison to Trump

Lin and Wagner said the Family Health Centers won’t turn away people who can’t pay, because as a federally recognized “safety net”  health service, their agency is able to get other funding to try to defray the costs.

But they said health care providers in private practice don’t have the ability to sustain losses from patients who can’t pay the copay.

And Wagner said making up the difference will still be a hit to the budget at Family Health Centers and other health care providers.

“It’s going to come off the bottom line,” he said.

Deborah Yetter: 502-582-4228; dyetter@courierjournal.com; Twitter: @d_yetter. Support strong local journalism by subscribing today: courier-journal.com/deborahy.

Medicaid copays

Here are some of the new copays some people covered by Medicaid are being charged, effective July 1.

>> Office visits for physician, dentist, vision care, behavioral health or other health provider:  $3

>> Prescription drugs: $1 for generic drugs, $4 to $8 for name-brand medication.

>> Outpatient hospital service: $4

>> Emergency room visit for non-emergency: $8

>> Hospital admission: $50

>> Durable medical equipment: $4

>> Laboratory or X-ray services: $3

>> Physical, speech or occupational therapy: $3

>> Chiropractor: $3

>> Podiatrist: $3

Source: Kentucky Cabinet for Health and Family Services

CONTINUE READING…

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The following can be called my rendition on the opioid/lack of Medical Marijuana/ crisis in Kentucky,

Fighting

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Support the Marijuana Justice Act

(…or whatever else you want to call it!)

Any way that you look at it, none of it passes the “smell test”!

From Robert Weber of the Kentucky Legislative Research Commission came the following account of  a meeting of both the Interim Joint Committee on Health and Welfare and Family Services, and the Medicaid Oversight and Advisory Committee.  The title was,

“Lawmakers hear sobering account of opioid crisis”,

It went on to say that “At one Kentucky hospital, people are actually bringing in heroin and shooting up with patients.”

The following can be called my rendition of the opioid crisis in Kentucky, which would probably apply in most places, but I live here and can only truly state what I’ve seen and what my own experience has been.

I see this issue from all sides.  The side of the Lawmakers who are trying to control the horrible issue at hand as well as the side of the patient who needs opioid medication and the opioid abuser as well, as I have had close family members deal with this issue not the least of which was my youngest daughter.

In 2015 I wrote about HB 1 in Kentucky and how it affected patients who were cut off from their opioid medications that they had been used to getting on a regular basis with little or no warning and the position it put them into.  Some of them couldn’t pass the urine test required because of intermittent Cannabis use, some of them were cut off because of other opiates showing up in their urine tests, and a lot of them were disenfranchised by their doctors who just cut everyone off because of fear of the DEA.  They PASSED their drug tests and still were turned away.

I have talked to several M.D.’s about the situation and they all told me the same thing – they are afraid to prescribe even to patients who are obviously in need of medication for fear of the DEA and losing their license to practice.  IF there is any amount of opiate in your drug screen they will definitely not prescribe, period.  It just doesn’t matter if it is only a little “pot”.  One of them went so far as to say that they thought it was population control!  I agreed with them!  The degree of death from heroin, buprenorphine and other even stronger pharmaceuticals than the ones that everyone was worried about killing people to begin with has created a population culling/control.  Get rid of the addicts! 

Now, imagine being a middle age person with chronic debilitating disease which causes pain, who has used marijuana for a very long time in order to keep from using too much opioid medication.  You go to your doctors appointment expecting to get your monthly prescription for 30 pain pills (not long-acting!),  so you can sleep at night and are requested to submit random urine test – which you fail, of course, because you smoked Cannabis for pain and severe anxiety – which leaves you out in the street – IF you have to have relief.  All I can say is thank God for Cannabis and the fact that it is a plant!  #PLANTSRIGHTS  

Now imagine being 25-30 years old, maybe older, having debilitating pain from a health issue, which Doctor’s conveniently prescribed a sh*tload of opiates of all kinds for, (i.e., the cocktails)… Don’t forget the Oxycontin which was sold to us as a non-addictive narcotic!  You probably do not use much Cannabis because you know you may be randomly tested, and you NEED those drugs!  BUT, you can get by with using a “spice” product, or a little meth, or a little of something else as long as it gets out of your system before you have to go to the Pain Clinic again!  SOMEHOW you miscalculate and low and behold a positive urine screen comes back for “whatever” and you are kicked out in the cold with absolutely nothing after having been on all those opiates and benzo’s and whatever else they wrote the ten prescriptions for the last time you were there, AFTER they injected your spine with a poison concoction of unknown chemicals.

What are you going to do when your Doctor refuses to prescribe and you are conveniently addicted to all those medications which you can ONLY get from a Physician at a pain clinic?

DETOX on your own?  You got to work to pay the bills!  Rent doesn’t go away just because your Doctor did!  Now you have to find something, somewhere, that will keep you going no matter what, and your gonna need to work more because the cost of “your medicine” is going to eat up your paycheck.  And then a lot of the “drugs” disappear off of the street – practically all at once – because everybody lost their Doctors.  Now what?  Never fear, Heroin is here. 

It is fucking human nature to find something to relieve pain.  Especially severe pain – ESPECIALLY if your already addicted to the opiates!  The Government made sure that everyone that was in “pain” was treated when they enacted the…

H.R. 756 (111th): National Pain Care Policy Act of 2009

Yeah, people are in pain.  In legitimate pain for a lot of reasons.  Years of abuse from employers, eating too much fast food which was sold to us by media marketing, abuse of alcohol and sugar and caffeine and tobacco.  Sedentary living in front of the TV.  Lack of exercise.  Bogus and unnecessary surgeries and medical mistakes and mishaps.  Veterans with service related injuries and mental issues.  The list goes on and on and on and EVERYONE is on this list somewhere.  They got us and they got our Children!  Hell, they even got our damn Dogs (tramadol)!  And then they gave the tramadol back to us!

Office of Drug Control Policy Executive Director Van Ingram testified that 1,404 Kentuckians died of a drug overdose last year.

In 2015 I posted this information which was attached to a link which is now defunct.  Imagine that.  At the time I did not print that information out and I haven’t had the time nor inclination to re-search it out again.  They effectively removed it from sight.  But it did exist and I think that it summarizes quite well how much the Kentucky Government felt about it’s opioid addicted Citizens.  Say what you will but I know there had to be a much better way to handle the situation!

One could theorize that the passage of HB50 which included a provision to “provide funding for the purchase and administration of naltrexone for extended-release injectable suspension”,   for Heroin overdoses was a calculated response to what they knew was going to happen when they discontinued “narcotics” at the Doctor’s office…more Heroin deaths.   Per the Interim Joint Committee on Judiciary on July 27, 2015…

Minutes of the 2nd Meeting of the 2015 Interim

July 27, 2015

The mandatory use of KASPER has resulted in three things: overall decreased prescribing of controlled substances, decreased inappropriate prescribing, and decreased “doctor shopping”. All three of these were goals of the bill, and all three have been successfully achieved. House Bill 217 was passed a year later, which cleaned up some parts of House Bill 1 and married the regulations to the statutory provisions. Representative Tilley asked members to note that those who are prescribing in high quantities are being monitored. Statistics have shown that since the passage of House Bill 1, heroin use increased. There has been an increase in heroin-related deaths.

Link:  http://www.lrc.ky.gov/LRCSiteSessionSearch/dtSearch/dtisapi6.dll?cmd=getdoc&DocId=752229&Index=E%3a\dtsearch_indexes\LRC_WebSite&HitCount=2&hits=11a+123+&SearchForm=

In what he described as a “rare bright spot, there were 70 million fewer dosage units of opioids prescribed last year in Kentucky than in 2011”. (That percentage doesn’t include buprenorphine, a semisynthetic opioid that is used to treat opioid addiction.) There are still about 300 million dosage units of opioids being prescribed in Kentucky.

Rep. Mary Lou Marzian, D-Louisville, asked how the state could fund the mental health, treatment and prevention programs needed.

The answer to Rep. Marzian’s question is that we won’t be funding mental health programs.  There is virtually no qualified Psychiatrist’s in the rural area’s of Kentucky and most of the people that they put in different “counseling services” to make it look like there is  mental health care are not qualified to handle the patients that they need to treat here. 

But there are plenty of “methodone clinics”.

Kentucky doctors have new restrictions for prescribing Suboxone after efforts to curb pill mills created a new cash-for-pills market and a street trade for the drug designed to safely wean addicts from heroin.
LINK

subs

Kentucky All Schedule Prescription Electronic Reporting Quarterly Trend Report 2nd Quarter 2017

The end result of all of this is that people are and will continue to suffer in Kentucky whether they be patients or addicts, or families of those who are patients or addicts.  The reasons for this can be debated over and over but it comes down to money.  And, how to ignore those who do not have any money. 

I, personally, am not a big fan of LEGALIZED medical marijuana, in and of itself.  I am surprised that Kentucky has not adopted that stance by now because when you “legalize” it, as a prescription medicine, you will open up all avenues for the prison industrial complex yet again.  It would be in their favor to “legalize” Marijuana for that reason – CONTROL.  However, the majority of Kentuckians have opted for “Medical Marijuana” and they have spoken loudly…

Let me say that I DO BELIEVE that their is room for regulated Cannabis in the Pharmaceutical market – BUT NOT at the expense of everyone’s rights to be able to grow this “medicinal” plant in our own backyard just as Oregano can be.  If the Government cannot do its job correctly and see that everyone is equally justified to use this plant as they see fit, then it should be immediately REPEALED from the CSA and any other Statute which may inflict harm upon a person for possessing, growing or using this plant!  Remove it from the Pharmacopeia and let the people do what they will with this plant.  We will learn to make our own medicine!

Another year has passed us by to no avail of Medical Cannabis in Kentucky.  Gov. Matt Bevin has made it clear what his intentions are at this time even though he had made “campaign promises” to many people to see that this issue was voted on favorably.  Yet we sit and wait.  What are we waiting for?

If it were my decision codeine, and hydrocodone – up to 5mg –  would be available at the pharmacy, with no prescription, with restrictions on how often you could purchase.  Since we have all the new monitoring programs this shouldn’t be hard to accomplish. 

As well, a low dose benzodiazepine should be made available as well.  And Cannabis medicines should be commonly available just as they were before 1937. 

Additionally, the Cannabis plant should be growing in everyone’s yard and it should be the first plant of choice for most everyday ailments – in addition to being a wonder drug to Cancer Patients and others with debilitating illnesses.   That is the beauty of Cannabis —  it can be utilized in so many different ways and help so many people.

God gave us all the plants and animals here on Planet Earth.

Why do people feel the need to steal them from us?

RELATED:

KASPER Reports and Studies
The Pharmacies Thriving in Kentucky’s Opioid-Stricken Towns
Drug that was supposed to stem Kentucky’s heroin epidemic creates a whole new problem
House Bill 1 Information
When pot means no prescription for pain
Physicians’ legal duty to relieve suffering
Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions
A patient denied a same-day appointment at a pain-management clinic in Las Vegas shot and injured two employees Thursday before fatally shooting himself, police said.
DEA Inflicts Harm on Chronic Pain Patients
https://pharmacy.ky.gov/Pages/Links.aspx
https://kentuckymarijuanaparty.com/2015/09/14/a-summary-of-two-doctors/
http://www.lrc.ky.gov/lrc/ExecutiveTeam.htm
https://kentuckymarijuanaparty.com/2015/09/24/all-roads-in-kentucky-lead-you-through-hell/
https://app.box.com/s/hyd7xxdsbtbxqvgjdwvepvxx1qa12vbv
https://shereekrider.wordpress.com/2015/10/26/rights-and-freedoms-may-in-no-case-be-exercised-contrary-to-purposes-and-principles-of-the-united-nations-how-the-united-nations-is-stealing-our-unalienable-rights-to-grow/

https://www.scribd.com/embeds/355207910/content?start_page=1&view_mode=scroll&access_key=key-u5FgJI9dW5qc0SFSjWdg&show_recommendations=true

Kentucky congressman says ‘Hell No’ to Obamacare replacement bill

Rep. Thomas Massie, R-Ky., listened during a committee session in 2013.

By Fernando Alfonso III

falfonso@herald-leader.com

A tweet from a Northern Kentucky congressman went viral Wednesday afternoon after he used his voting card to double down on his disdain for the American Health Care Act, the Republicans’ attempt to replace Obamacare.

Rep. Thomas Massie’s tweet features a photo of his “new” voting card and the words “HELL NO” on it. Within two hours after sending the message, Massie, who manages his own Twitter account, could not believe it had collected more than 8,200 likes and 3,000 retweets.

“I didn’t expect it to go viral. I thought maybe we’d get 5 percent of that,” Massie said over the phone in Washington, D.C., on Wednesday afternoon. “It’s another version of Obamacare, in my opinion, and it’s not as well thought out. We need to leave the socialism to the socialists. If I thought the bill were a glass half full proposition, better than the status quo, I’d vote for it. But I think it will make insurance premiums go up.”


Sen. Rand Paul predicts House will vote down GOP health plan

“It’s important for Republicans to understand that once we pass something, we will own it,” Sen. Rand Paul said of the GOP health care plan. “If what we pass is not going to work, it’s a bad thing to own.”

jbrammer@herald-leader.com


The AHCA would replace the subsidies in Obamacare, otherwise known as the Affordable Care Act, with a flat tax credit that would not account for income or local insurance prices. The new law would also allow insurers to charge older people five times what they charge younger customers, compared to three times under Obama’s health care law, according to the Associated Press.

Massie, a Republican, has made his displeasure over AHCA clear on Twitter over the past week through hashtags like #sassywithmassie.

“(The proposal) just won’t work and Republicans will get blamed for escalating health insurance costs,” Massie said. “The bill doesn’t do enough to reduce the cost of health care. I feel the momentum is against the bill. I don’t see any of my colleagues changing their votes and they’ve had 24 hours to switch people from a no to a yes to no avail.”

Angry constituents confront U.S. Rep. Andy Barr about GOP health care bill

U.S. Rep Andy Barr faced angry constituents in Richmond, Ky., during a town hall on Saturday, March 18, 2017. Barr was defending the Republican proposal to replace the federal Affordable Care Act.

Daniel Desrochers ddesrochers@herald-leader.com

Fernando Alfonso III: 859-231-1324, @fernalfonso

Related content

5 things to know about the CBO’s report on Paul Ryan’s ACA replacement

CONTINUE READING AND TO VIDEO!

In chaotic scene, Rand Paul demands to see the House GOP’s Obamacare repeal bill

By Lauren Fox and Phil Mattingly, CNN

Updated 3:25 PM ET, Thu March 2, 2017

Rand Paul 3.2.17

Senator demands to see ‘secret’ Obamacare bill 01:59

Story highlights
  • Some House Republicans were being granted a chance to review an Obamacare repeal draft
  • GOP leadership has taken a new level of caution with their Obamacare legislation

(CNN)  Kentucky Republican Sen. Rand Paul marched to the House side of the Capitol Thursday morning, knocked on a locked door and demanded to see a copy of the House’s bill to repeal and replace the Affordable Care Act, which he believed was being kept under lock and key.

Aides in the room told the senator — before dozens of reporters in a crowded hallway — that there was no bill to see. In fact, it wasn’t the room where GOP members of the Energy and Commerce Committee were told to meet with staff to review the current draft of their bill at all. But that did little to dissuade Paul, openly critical to the House Republican leadership’s preferred path on the process, from making his underlying point.

“This should be an open and transparent process,” Paul said. “This is being presented as if it were a national secret, as if this was a plot to invade another country, as if this were national security. That’s wrong.”

    Paul ventured to the House Thursday afternoon after reports surfaced that House Republicans on the Energy and Commerce Committee were being granted an opportunity to review the current draft of the Obamacare repeal legislation and ask questions behind closed doors.

    Opposed to the House legislation’s principles, Paul said he wanted to see the bill himself even though he didn’t serve on the committee.

    “I’m not allowed to read the working product so I can comment on it?” he said.

    Outside the small House office, the chaotic scene continued with a handful of Democrats demanding they, too, see the legislation, which aides continued to say was not even in the room. Two Democrats on the Energy and Commerce Committee and House Minority Whip Steny Hoyer, a Democrat from Maryland, asked aides if the bill was ready, only to be rebuffed.

    “I want to see the bill. I want to read the bill,” New York Democrat Paul Tonko said, noting that as far as he knew, Republicans were still planning to move forward with a markup on the legislation next week.

    At one point, the GOP staff allowed Hoyer, Rep. Joe Kennedy and a dozen or so reporters into the room to inspect it themselves. It was, in fact, bill-less.

    Hoyer proceeded to hold an impromptu news conference near a bust of President Abraham Lincoln a few feet away from the misidentified room. He then held an imaginary conversation with the 16th president about what Hoyer said was the poor state of the Republican Party.

    Rep. Greg Walden, the chairman of the Energy and Commerce Committee, downplayed perceptions of secrecy in a statement Thursday.

    “Reports that the Energy and Commerce Committee is doing anything other than the regular process of keeping its members up to speed on latest developments in its jurisdictions are false. Simply put, Energy and Commerce majority members and staff are continuing to discuss and refine draft legislative language on issues under our committee’s jurisdiction.”

    Leadership has taken a new level of caution with Obamacare repeal and replace reconciliation drafts after a leaked version of the bill in progress was circulated to news outlets last week.

    House aides told CNN that the review process was simply part of regular procedure of giving their members an opportunity to review the current draft and ask committee staff questions. The committee — along with a second panel responsible for the repeal legislation — is tentatively shooting to consider their respective pieces of legislation as soon as next week.

    The leaked draft — which aides say was outdated — drew condemnations from conservatives who pledged to oppose any final bill and set off a new round of internal divisions that threatened to endanger the repeal process before it even gets off the ground.

    CONTINUE READING AND TO VIDEO…

    In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks

     

    November 19, 20166:00 AM ET

    Phil Galewitz

     

    For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America’s poorest places, the Affordable Care Act was life altering.

    The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

    “It’s been a godsend to me,” said the former Ohio school custodian who moved to Kentucky a decade ago.

    Lockaby finally got treated for a thyroid disorder that had left her so exhausted she’d almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

    But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state’s Republican governor has submitted to the Obama administration.

    Next year will likely bring more uncertainty when a Trump administration and a GOP-controlled Congress promise to consider Obamacare’s repeal, including a potential reduction in the associated Medicaid expansion in 31 states and the District of Columbia that has led to health coverage for an estimated 10 million people.

    What Happens If Kentucky Dismantles Its Health Insurance Exchange?

    Kentucky Gov. Matt Bevin, who was elected in 2015, has argued his state can’t afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky’s enrollment has doubled since late 2013 and today almost a third of its residents are in the program. The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state’s uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.

    Kentucky’s achievement owed much to the success of its state-run exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin’s Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.

    Bevin has threatened to roll back the expansion if the Obama administration doesn’t allow him to make major changes, such as requiring Kentucky’s beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.

    Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.

    In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin’s view — $1.2 billion from 2017 to 2021, according to the waiver request he’s made to the Obama administration to change how Medicaid works in his state.

    Trump’s unexpected victory may help Bevin’s chances of winning approval. Before the election, many analysts expected federal officials to reject the governor’s plan by the end of the year on the grounds that it would roll back gains in expected coverage.

    A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.

    “I think it’s much more likely that a waiver could be approved under the Trump administration,” she said. “On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed.”

    Lockaby is watching with alarm: “I am worried to death about it.”

    Life already is hard in her part of Kentucky’s coal country, where once-dependable mining jobs are mostly gone.

    In Clay County where Lockaby lives, 38 percent of the population live in poverty. A fifth of the residents are disabled. Life expectancy is eight years below the nation’s average.

    Clay’s location places it inside an area familiar to public health specialists as the South’s diabetes and stroke belt. It’s also in the so-called “Coronary Valley” encompassing the 10-state Ohio/Mississippi valley region.

    About 60 percent of Clay County’s 21,000 residents are covered by Medicaid, up from about a third before the expansion. The counties uninsured rate for nonelderly adults has fallen from 29 percent to 10 percent.

    Still, the increase in insurance coverage hasn’t made Clay’s people healthier yet. Local health officials here say achieving that will take a decade or more. Instead, they cite progress in smaller steps: more cancer screenings, more visits to mental health professionals and more prescriptions getting filled. Harder lifestyle changes that are still ahead — such as eating better, quitting smoking and regular exercise — will take more than a couple years to happen, said Aaron Yelowitz, associate professor of economics at the University of Kentucky.

    One hopeful spot is the Grace Community Health Center in downtown Manchester, where patient visits are up more than 20 percent since 2014. Those without insurance pay on a sliding scale, which can mean a visit costs $50 or more.

    That was too much for Ramiro Salazar, 47, who lives with his wife and two children on a $733 monthly income. With Medicaid, he sees a doctor for his foot and ankle pain, meets regularly with a psychologist for anxiety and gets medications — all free to him. Medicaid even covers his transportation costs to doctors, vital because a specialist can be 40 miles away.

    Salazar is worried about Bevin’s plans, especially the additional costs. “I probably couldn’t afford it as I’m unemployed,” he said. “It would hurt me pretty bad.”

    Any development that could take away health coverage from people with mental health issues worries Joan Nantz, a psychologist who works part time at Grace and whose appointment calendar is booked three weeks out because of patient demand. More than 90 percent of her clients are on Medicaid.

    “If something happens to this program, I can’t begin to think what impact it would have on society,” she said. Without counseling, people with mental health issues will resort to illegal drugs and be more likely to commit crimes and domestic violence, Nantz said.

    Just five primary care doctors in Manchester treat adults in Clay and surrounding counties. Manchester Memorial Hospital has tried to recruit more without success.

    “We had a painful primary care shortage here five years ago and now it’s worse,” said Dr. Jeffrey Newswanger, an emergency room physician and chief medical officer at the hospital. “Just because they have a Medicaid card doesn’t mean they have doctors.”

    The emergency room is busier than ever seeing patients for primary care needs, he said.

    Newswanger sees both sides to the debate over Medicaid. The hospital gained because more patients are now covered by insurance, and the ER’s uninsured rate dropped to 2 percent from 10 percent in 2013.

    “Eliminating the expansion altogether would be painful for the hospital and a disaster for the community,” he said.

    But, Newswanger also appreciates some of Bevin’s proposals.

    “No one values something that they get for free,” he said, and incentives are needed to make people seek care in doctors’ offices instead of expensive ERs.

    Christie Green, public health director of the Cumberland Valley District Health Department that covers Clay County, said making the poor pay more or scrapping Medicaid’s expansion would be a setback to improving people’s health.

    Last year, Green helped Manchester build a three-mile trail along a park and install a swinging bridge across a small creek. Both additions were intended to promote physical fitness in a place where more than a third smoke — both far above national averages.

    Progress is slow. The path is used regularly. But drug addicts congregate daily by the bridge and it rarely gets traffic.

    “There is a lot to overcome here,” Green said.

    This story was produced through collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. You can follow Phil Galewitz on Twitter: @philgalewitz.

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    Proposed Medicaid Changes in Kentucky – Tell us what you think about Governor Bevin’s proposed Medicaid changes

    Proposed Medicaid Changes in Kentucky – Tell us what you think about Governor Bevin’s proposed Medicaid changes – LINK

    PLEASE FOLLOW LINK ABOVE TO COMPLETE THIS IMPORTANT SURVEY!  YOUR HEALTHCARE IS AT RISK IN KENTUCKY!  NOW IS THE TIME TO SPEAK UP!

     


     

    United 874K Members and Supporters –
    The three public hearings on the proposed Medicaid waiver have been completed, with approximately 400 individuals in attendance in Bowling Green, Frankfort and Hazard, KY and nearly 100 individuals who spoke. 98% of those who spoke expressed concerns about the proposed waiver. Concerns were expressed about requiring the “medically frail” to pay monthly premiums; about a work or volunteer requirement of 20 hours/week for those on the Medicaid Expansion; loss of retroactive eligibility which could cause a lapse in coverage or a delay in beginning Medicaid coverage; increasing premiums over several years for some Medicaid members, with a 6-month lock-out from services if the premium is not paid; eliminating annual dental and vision check-ups and routine care for the Medicaid Expansion folks
    Clearly those Medicaid members who are deemed to be “medically frail” (by a process yet to be determined, but ostensibly those with SMI. Chronic SUD, complicated medical conditions, are on SSI, or have a disability that interferes with a task of daily living) will be charged a monthly premium, probably in the range of $1 – $8 / month. We are concerned both by the financial burden, but also by the administrative burden created by this requirement. If the premium is not paid, then the medically frail individual will have to pay a copay for every service and every medication! While the 1915 C Waivers are exempt from this current 1115 Waiver Proposal from the Administration, we are concerned about individuals who are currently covered by Medicaid while waiting for a 1915 waiver slot. They would likely be classified as “medically frail” and would be subject to a monthly premium; if not paid, then they would be charged a copay for each health service and each medication they receive.
    Medically frail individuals will not have a work or volunteer requirement and will have the full range of current benefits, including dental and vision. These latter benefits (annual check-up, routine cleanings, etc.) are being removed from the benefit package for all other Medicaid members (excluding children and pregnant women); those basic health benefits will have to be “earned” by the member through their Rewards Account.
    I urge you to spread the word and to encourage those affected by these waiver changes, their families, providers and advocates to submit comments! I am available to answer questions or to be of assistance, if you will contact me.
    I have attached a flyer which gives information about writing or emailing your comments about the waiver to Medicaid Commissioner Miller. THE DEADLINE FOR RECEIPT OF WRITTEN COMMENTS IS 5:00 P.M. ON FRIDAY, JULY 22, 2016! Volume is important, so please encourage everyone to write in. And send a copy of your comment to kymedicaidchanges@gmail.com so we can be sure that your voice is heard!
    I have also attached a brief description of the waiver proposal and how it would affect various groups of people who are now Medicaid members.
    KY Voices for Health is conducting a very short SURVEY about the proposed changes in Medicaid. Please distribute this link and ask folks to complete the survey! It takes less than 3-4 minutes.

    UK gets $6 million grant to research cocaine addiction

    Saturday, November 21, 2015 

     

    Posted: Saturday, November 21, 2015 12:22 AM

    By Linda B. Blackford Lexington Herald-Leader

    LEXINGTON – A group of University of Kentucky researchers has won a $6 million grant to further develop a potential treatment for cocaine abuse.

    UK College of Pharmacy professor Chang-Guo Zhan, along with UK professors Fang Zheng and Sharon Walsh, and Wake Forest University professor Mei-Chuan Ko, are researching new therapies for overdose and addiction.

    “Dr. Zhan’s groundbreaking work in this field cannot be overstated,” interim dean Kelly M. Smith said. “There currently is no FDA approved treatment for cocaine overdose or cocaine addiction, and Dr. Zhan and his research team are trying to change that. Developing such therapies would be a major breakthrough for health care.”

    Previously, Zhan’s team designed and tested CocH1, an enzyme that breaks down cocaine in the bloodstream without producing harmful byproducts in the body.

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