New study finds texting and driving kills and injures more teens than drinking and driving, and is becoming more prevalent

A new study finds that texting while driving has become more dangerous among teenagers than drinking and driving, and it says the number of teens who are dying or being injured as a result of this habit has "skyrocketed."

Nationwide, more than 3,000 teens are killed and 300,000 are injured as a result of texting and driving, compared to 2,700 deaths and 282,000 injuries from drinking and driving, said researchers at Cohen Children's Medical Center in New Hyde Park, N.Y.

"A person who is texting can be as impaired as a driver who is legally drunk," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen.

Adesman and his team found that the number of teens who text and drive exceed the number who drink and drive, that more boys admit to texting than girls, and that texting increases with age, writes Delthia Ricks of Newsday. While teens' texting is increasing, the CDC reports alcohol use among teen drivers has decreased by 54 percent over the past 14 years.

On Wednesday, officials from the National Highway Traffic Safety Administration described texting as among the worst of driver distractions, and Adesman says texting is as hazardous as "drinking and driving, binge drinking, drug and tobacco use, unsafe sex and tanning devices," writes Ricks.

"We have very strong taboos against drinking and driving. Kids don't drink and drive every day," Adesman said. "But some kids are out there texting and driving seven days a week -- and they admit it."

A new study finds that texting while driving has become more dangerous among teenagers than drinking and driving, and it says the number of teens who are dying or being injured as a result of this habit has "skyrocketed."

Nationwide, more than 3,000 teens are killed and 300,000 are injured as a result of texting and driving, compared to 2,700 deaths and 282,000 injuries from drinking and driving, said researchers at Cohen Children's Medical Center in New Hyde Park, N.Y.

"A person who is texting can be as impaired as a driver who is legally drunk," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen.

Adesman and his team found that the number of teens who text and drive exceed the number who drink and drive, that more boys admit to texting than girls, and that texting increases with age, writes Delthia Ricks of Newsday. While teens' texting is increasing, the CDC reports alcohol use among teen drivers has decreased by 54 percent over the past 14 years.

On Wednesday, officials from the National Highway Traffic Safety Administration described texting as among the worst of driver distractions, and Adesman says texting is as hazardous as "drinking and driving, binge drinking, drug and tobacco use, unsafe sex and tanning devices," writes Ricks.

"We have very strong taboos against drinking and driving. Kids don't drink and drive every day," Adesman said. "But some kids are out there texting and driving seven days a week -- and they admit it."

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Bankruptcy filing by mental-health agency is a loser for Kentucky, where such services can be scarce and little used

By Molly Burchett
Kentucky Health News

The decision of Seven Counties Services Inc. to file bankruptcy to avoid paying into the Kentucky Employee Retirement System has created a "no win" situation for the state, and the issue may add yet another obstacle for Kentuckians to get the mental health care they need.

Louisville-based Seven Counties is one of the state's largest mental-health agencies, serving more than 30,000 adults and children with mental-health services, alcohol and drug-abuse treatment, developmental-disabilities services and preventive programs, according to its website.

And while Kentucky's mental-health system has received an F grade for its funding, the state pension system needs agencies like Seven Counties to pay in more because the system is just 27 percent funded. "Employers will have to ante up around 38 percent of annual payroll, compared with the 23 percent now required," Mike Wynn notes in The Courier-Journal.

Kentucky's need for mental health services is much greater than the supply, and an estimated 1.7 million Kentuckians live in areas designated as a "mental health professional shortage area," which means almost 40 percent of Kentucky residents lack proper access to such professionals, says a report by the Kaiser Family Foundation. About 24 percent of residents' mental-health care needs are under-served, and this situation could be worsened by federal health reform, which will expand mental-health and substance-abuse treatment benefits to more Kentuckians without adding to the number of providers.

Bankruptcy for Seven Counties is a lose-lose proposition: It could close its doors in 2014 and stop providing services to 30,000 Kentuckians or, if the bankruptcy goes through, the state's retirement system wouldn't get anticipated agency payments into the system, reports Ryan Alessi of cn|2, a news service of the Time Warner and Insight cable-TV companies.

“The only two paths this can go is we could stay in KERS until we have given them our last nickel, which is a year (or) year-and-a-half from now … (and) we close the doors and go out of business and KERS gets no more money because we’re out of business,” Dr. Tony Zipple, president of Seven Counties, told Alessi.

In addition to funding problems for mental-health services, many people with mental-health issues don't seek treatment because of its stigma, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition, in a recent opinion piece sent to Kentucky newspapers.  Shuster calls on elected leaders to increase funding of mental health services and highlights the prevalence of mental health illness.

"At least one-fourth of us will experience a behavioral health issues (mental illness or substance use disorder) in a given year," Schuster writes. That number, and the number of people needing treatment, will continue to grow, she says.

Schuster also writes about the societal impact of not treating mental illness: "Depression is rated as the #1 cause of disability in this country, and is a leading cause of absenteeism and decreased productivity in the work force." Because some people avoid treatment due to stigma, they may self-medicate with drugs or alcohol, and "the effects of stigma and failure to treat the whole person can have catastrophic results," she writes.

In addition to calling for more mental health funding, Schuster asks all Kentuckians to get educated about mental illness so that its stigma can be erased. Click here to read more from Schuster about mental health and resources for help. For a PDF of her op-ed, click here; for a text version, here.

By Molly Burchett
Kentucky Health News

The decision of Seven Counties Services Inc. to file bankruptcy to avoid paying into the Kentucky Employee Retirement System has created a "no win" situation for the state, and the issue may add yet another obstacle for Kentuckians to get the mental health care they need.

Louisville-based Seven Counties is one of the state's largest mental-health agencies, serving more than 30,000 adults and children with mental-health services, alcohol and drug-abuse treatment, developmental-disabilities services and preventive programs, according to its website.

And while Kentucky's mental-health system has received an F grade for its funding, the state pension system needs agencies like Seven Counties to pay in more because the system is just 27 percent funded. "Employers will have to ante up around 38 percent of annual payroll, compared with the 23 percent now required," Mike Wynn notes in The Courier-Journal.

Kentucky's need for mental health services is much greater than the supply, and an estimated 1.7 million Kentuckians live in areas designated as a "mental health professional shortage area," which means almost 40 percent of Kentucky residents lack proper access to such professionals, says a report by the Kaiser Family Foundation. About 24 percent of residents' mental-health care needs are under-served, and this situation could be worsened by federal health reform, which will expand mental-health and substance-abuse treatment benefits to more Kentuckians without adding to the number of providers.

Bankruptcy for Seven Counties is a lose-lose proposition: It could close its doors in 2014 and stop providing services to 30,000 Kentuckians or, if the bankruptcy goes through, the state's retirement system wouldn't get anticipated agency payments into the system, reports Ryan Alessi of cn|2, a news service of the Time Warner and Insight cable-TV companies.

“The only two paths this can go is we could stay in KERS until we have given them our last nickel, which is a year (or) year-and-a-half from now … (and) we close the doors and go out of business and KERS gets no more money because we’re out of business,” Dr. Tony Zipple, president of Seven Counties, told Alessi.

In addition to funding problems for mental-health services, many people with mental-health issues don't seek treatment because of its stigma, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition, in a recent opinion piece sent to Kentucky newspapers.  Shuster calls on elected leaders to increase funding of mental health services and highlights the prevalence of mental health illness.

"At least one-fourth of us will experience a behavioral health issues (mental illness or substance use disorder) in a given year," Schuster writes. That number, and the number of people needing treatment, will continue to grow, she says.

Schuster also writes about the societal impact of not treating mental illness: "Depression is rated as the #1 cause of disability in this country, and is a leading cause of absenteeism and decreased productivity in the work force." Because some people avoid treatment due to stigma, they may self-medicate with drugs or alcohol, and "the effects of stigma and failure to treat the whole person can have catastrophic results," she writes.

In addition to calling for more mental health funding, Schuster asks all Kentuckians to get educated about mental illness so that its stigma can be erased. Click here to read more from Schuster about mental health and resources for help. For a PDF of her op-ed, click here; for a text version, here.

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Parents should talk to children about alcohol; study shows teens do listen

Two recent studies highlight how important it is for parent to talk with their teens about the risks of alcohol use, which leads to more than 4,500 deaths nationwide every year.

In the first study, Mothers Against Drunk Driving found that fewer than a third of alcohol-related deaths among 15- to 20-year-olds are caused by drinking and driving. About 32 percent of the drinking-related deaths involved traffic crashes, while 68 percent involved incidents such as murder (30 percent), suicide (14 percent), alcohol poisoning (9 percent) and other causes (15 percent), MADD says in a press release.

"These data show that taking away the keys truly does not take away all of the risks when it comes to underage drinking," MADD national president Jan Withers said. "MADD hopes this information will inspire parents to have ongoing conversations with their kids about the dangers of drinking alcohol before age 21, especially since we know that a majority of kids say their parents are the biggest influence on their decisions about alcohol."

Another study says parents can help reduce children's excessive drinking in college by talking with them about the potential dangers of excessive drinking before they set foot on campus, and it turns out that children really do listen to their parents about drinking, says the study by Rob Turrisi of Penn State. Discussing drinking in any way before teens go to campus, including why some teens drink while others don't, as well as the potential dangers of excessive drinking, can help.

Having this type of conversation with teens about the reality of underage drinking and its risks, such as alcoholism and alcohol poisoning, and can reduce the odds that light drinkers will escalate into excessive drinkers, says the study. It can also increase the likelihood that already heavy-drinking teens cut down on their drinking or even stop completely.

The National Institute on Alcohol Abuse and Alcoholism also urges parents to talk with their children about alcohol. Click here for more information about doing this or to read about the risks of alcohol use and other prevention strategies.

Two recent studies highlight how important it is for parent to talk with their teens about the risks of alcohol use, which leads to more than 4,500 deaths nationwide every year.

In the first study, Mothers Against Drunk Driving found that fewer than a third of alcohol-related deaths among 15- to 20-year-olds are caused by drinking and driving. About 32 percent of the drinking-related deaths involved traffic crashes, while 68 percent involved incidents such as murder (30 percent), suicide (14 percent), alcohol poisoning (9 percent) and other causes (15 percent), MADD says in a press release.

"These data show that taking away the keys truly does not take away all of the risks when it comes to underage drinking," MADD national president Jan Withers said. "MADD hopes this information will inspire parents to have ongoing conversations with their kids about the dangers of drinking alcohol before age 21, especially since we know that a majority of kids say their parents are the biggest influence on their decisions about alcohol."

Another study says parents can help reduce children's excessive drinking in college by talking with them about the potential dangers of excessive drinking before they set foot on campus, and it turns out that children really do listen to their parents about drinking, says the study by Rob Turrisi of Penn State. Discussing drinking in any way before teens go to campus, including why some teens drink while others don't, as well as the potential dangers of excessive drinking, can help.

Having this type of conversation with teens about the reality of underage drinking and its risks, such as alcoholism and alcohol poisoning, and can reduce the odds that light drinkers will escalate into excessive drinkers, says the study. It can also increase the likelihood that already heavy-drinking teens cut down on their drinking or even stop completely.

The National Institute on Alcohol Abuse and Alcoholism also urges parents to talk with their children about alcohol. Click here for more information about doing this or to read about the risks of alcohol use and other prevention strategies.

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If you're dieting, remember that alcohol has calories too

Alcoholic beverages could throw a wrench into your 2013 diet plan.  The National Center for Health Statistics reported late last year that American adults drink in an average of 100 calories daily from beer, wine and other alcoholic beverages, and almost 20 percent of men and 6 percent of women consume more than 300 calories daily from alcohol.

Men ages 20 to 39 consume the most alcohol, taking in about 175 calories per day on average, while women in the same age group consume about 60 calories daily per person.

"It is certainly not a good health strategy to have alcohol calories constituting a significant percentage of total calorie consumption," health advisers Dian and Tom Griesel say on Newswise, a research-reporting service. "This is especially true for women and those dieting who would be better off avoiding all alcoholic beverages until their weight goals are met or at most limiting alcohol to one drink no more than two days a week."

Griesel also said that current dietary guidelines recommend to consume alcohol in moderation, which means no more than one daily drink for women and two for men.  So, as you reach for the apple instead of candy, remember that there are empty calories in your drink of choice too. (Read more)

Alcoholic beverages could throw a wrench into your 2013 diet plan.  The National Center for Health Statistics reported late last year that American adults drink in an average of 100 calories daily from beer, wine and other alcoholic beverages, and almost 20 percent of men and 6 percent of women consume more than 300 calories daily from alcohol.

Men ages 20 to 39 consume the most alcohol, taking in about 175 calories per day on average, while women in the same age group consume about 60 calories daily per person.

"It is certainly not a good health strategy to have alcohol calories constituting a significant percentage of total calorie consumption," health advisers Dian and Tom Griesel say on Newswise, a research-reporting service. "This is especially true for women and those dieting who would be better off avoiding all alcoholic beverages until their weight goals are met or at most limiting alcohol to one drink no more than two days a week."

Griesel also said that current dietary guidelines recommend to consume alcohol in moderation, which means no more than one daily drink for women and two for men.  So, as you reach for the apple instead of candy, remember that there are empty calories in your drink of choice too. (Read more)

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U.S. teens' cigarette use drops to a new low, but use of alcohol goes up a bit and more 12th graders are smoking marijuana

Teenagers' cigarette smoking dropped to a record low this year but alcohol use rose slightly after seven years of decline, according to a survey of 45,000 eighth-, 10th- and 12th- graders for the National Institute of Drug Abuse.

The survey also found that the use of illicit drugs dropped slightly among eighth-graders but rose slightly among 12th-graders. Among them, 36.4 percent reported using marijuana in the past year, up from 34.8 percent in 2010, and the share who saw great risk in smoking marijuana occasionally dropped significantly, to 20.6 percent, from 24.5 percent in 2010.

Among all three age groups, only 10.6 percent said they had smoked cigarettes in the past 30 days, down from 11.7 percent in 2010. The University of Michigan researchers who did the survey said the decline was significant, and may have been driven by a big increase in the federal tobacco tax in 2009.

"A 1-percentage-point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," principal researcher Lloyd Johnston said in a news release. Among eighth-graders, the decline was about 20 percent. For other results of the survey, click here; for a PDF version, here. For the full survey report, go here.

"Teen attitudes toward smoking also continued to become more negative. For example, 80 percent of teens said they preferred to date nonsmokers in 2012," Steve Gorman reports for Reuters. "But anti-tobacco advocates said their battle to stamp out teen smoking was far from over, noting that 17 percent of high school seniors still graduate as smokers." And the figure is higher in many rural areas.

Kentucky ranks at or near the top in youth smoking. In 2010, the last year for which state figures are available, 16 percent of Kentucky children aged 12 to 17 (a slightly younger group than the one above) reported smoking a cigarette in the past month. The national rate for that age group was 10 percent, according to the Centers for Disease Control and Prevention.

Teenagers' cigarette smoking dropped to a record low this year but alcohol use rose slightly after seven years of decline, according to a survey of 45,000 eighth-, 10th- and 12th- graders for the National Institute of Drug Abuse.

The survey also found that the use of illicit drugs dropped slightly among eighth-graders but rose slightly among 12th-graders. Among them, 36.4 percent reported using marijuana in the past year, up from 34.8 percent in 2010, and the share who saw great risk in smoking marijuana occasionally dropped significantly, to 20.6 percent, from 24.5 percent in 2010.

Among all three age groups, only 10.6 percent said they had smoked cigarettes in the past 30 days, down from 11.7 percent in 2010. The University of Michigan researchers who did the survey said the decline was significant, and may have been driven by a big increase in the federal tobacco tax in 2009.

"A 1-percentage-point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," principal researcher Lloyd Johnston said in a news release. Among eighth-graders, the decline was about 20 percent. For other results of the survey, click here; for a PDF version, here. For the full survey report, go here.

"Teen attitudes toward smoking also continued to become more negative. For example, 80 percent of teens said they preferred to date nonsmokers in 2012," Steve Gorman reports for Reuters. "But anti-tobacco advocates said their battle to stamp out teen smoking was far from over, noting that 17 percent of high school seniors still graduate as smokers." And the figure is higher in many rural areas.

Kentucky ranks at or near the top in youth smoking. In 2010, the last year for which state figures are available, 16 percent of Kentucky children aged 12 to 17 (a slightly younger group than the one above) reported smoking a cigarette in the past month. The national rate for that age group was 10 percent, according to the Centers for Disease Control and Prevention.

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Annual health ratings of states still puts Kentucky 44th

Kentucky ranks 44th among the 50 states in overall health in United Health Foundation's America's Health Rankings. Darla Carter of The Courier-Journal reports that while this is the same rating Kentucky achieved last year, the state is not without some high points. Among them, Kentucky is 9th best nationwide for its low incidence of binge drinking. We are to be congratulated as well for our low violent crime, high immunization coverage and improved high-school graduation rate.

Smoking continues to be where Kentucky fails miserably. Still worst, with 29 percent of the population as smokers, the state also faces an uphill battle with more than 1 million obese adults and a high rate of cancer deaths. The state also needs to continue to improve its ability to control the nation's highest rate of preventable hospitalizations.

The rankings are published by the United Health Group's foundation, along with the American Public Health Association and the Partnership for Prevention. Kentucky’s challenges include having the nation’s highest smoking rate, more than 1 million obese adults and a high rate of cancer deaths. See more on Kentucky's ratings here. (Read more)

Kentucky ranks 44th among the 50 states in overall health in United Health Foundation's America's Health Rankings. Darla Carter of The Courier-Journal reports that while this is the same rating Kentucky achieved last year, the state is not without some high points. Among them, Kentucky is 9th best nationwide for its low incidence of binge drinking. We are to be congratulated as well for our low violent crime, high immunization coverage and improved high-school graduation rate.

Smoking continues to be where Kentucky fails miserably. Still worst, with 29 percent of the population as smokers, the state also faces an uphill battle with more than 1 million obese adults and a high rate of cancer deaths. The state also needs to continue to improve its ability to control the nation's highest rate of preventable hospitalizations.

The rankings are published by the United Health Group's foundation, along with the American Public Health Association and the Partnership for Prevention. Kentucky’s challenges include having the nation’s highest smoking rate, more than 1 million obese adults and a high rate of cancer deaths. See more on Kentucky's ratings here. (Read more)

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Kentucky teens attempt suicide more often than those in all U.S.

In a 2011 update of a study done four years ago, the U.S. Department of Health and Human Services Office of Adolescent Health (OAH) surveyed America's teenagers about their physical health and potentially risky behaviors. Broken down state-by-state, the study presents a picture of what ails us, if we are willing to pay attention.

In Kentucky, the numbers read as not terribly surprising. Our kids are a little more fat than the national average. They smoke and chew more tobacco. They have a little more sex while in high school. But one statistic is startling: Kentucky's teenagers are trying to kill themselves more frequently than other teenagers nationwide.

According to data collected by the Centers for Disease Control and Prevention last month, 11 percent of Kentucky youth have attempted suicide, compared to 8 percent nationally. Moreover, 5 percent of Kentucky's teenagers have had a suicide attempt result in an injury, poisoning or overdose that had to be treated by a doctor or nurse during the 12-month period before the survey was conducted. That compares to only 2 percent nationwide for kids responding who required the same treatment during the same duration.

If there is good news for Kentucky in the survey, it's this: The state's teenagers are in reasonably good health, but are not getting the physical exercise that the rest of the nation's teens are getting (39 percent vs. 49 percent) and they are playing fewer team sports (46 percent vs. 58 percent). They are heavier (16 percent vs. 13 percent) than the average American teen and more likely (36 percent to 28 percent) to drink a can, bottle or glass of soda or pop one or more times a day.

They are less likely to have never tried smoking (41 percent  to 55 percent) than other American teens, to have smoked on a least one day of the last 30 (24 percent to 18 percent), bought their own cigarettes (21 percent to 14 percent) and used chewing tobacco (17 percent to 8 percent). Eight percent of Kentucky teenagers report using pain relievers for non-medical reasons in the last 12 months. That's a bit higher than the national average of 6 percent of U.S. teens who report doing the same.

Kentucky's teenagers are also a bit more likely to have had sexual intercourse while in high school (52 to 47 percent) than the national average, more likely to carried a weapon on a least one day (23 percent o 17 percent), carried a gun (9 percent to 5 percent), though less likely to have been in a physical fight (29 to 33 percent).

To find each of these topics, go here. Look for the heading (physical health, mental health, substance abuse, healthy relationships), then go to the Kentucky site page. A more complete data picture will emerge.

In a 2011 update of a study done four years ago, the U.S. Department of Health and Human Services Office of Adolescent Health (OAH) surveyed America's teenagers about their physical health and potentially risky behaviors. Broken down state-by-state, the study presents a picture of what ails us, if we are willing to pay attention.

In Kentucky, the numbers read as not terribly surprising. Our kids are a little more fat than the national average. They smoke and chew more tobacco. They have a little more sex while in high school. But one statistic is startling: Kentucky's teenagers are trying to kill themselves more frequently than other teenagers nationwide.

According to data collected by the Centers for Disease Control and Prevention last month, 11 percent of Kentucky youth have attempted suicide, compared to 8 percent nationally. Moreover, 5 percent of Kentucky's teenagers have had a suicide attempt result in an injury, poisoning or overdose that had to be treated by a doctor or nurse during the 12-month period before the survey was conducted. That compares to only 2 percent nationwide for kids responding who required the same treatment during the same duration.

If there is good news for Kentucky in the survey, it's this: The state's teenagers are in reasonably good health, but are not getting the physical exercise that the rest of the nation's teens are getting (39 percent vs. 49 percent) and they are playing fewer team sports (46 percent vs. 58 percent). They are heavier (16 percent vs. 13 percent) than the average American teen and more likely (36 percent to 28 percent) to drink a can, bottle or glass of soda or pop one or more times a day.

They are less likely to have never tried smoking (41 percent  to 55 percent) than other American teens, to have smoked on a least one day of the last 30 (24 percent to 18 percent), bought their own cigarettes (21 percent to 14 percent) and used chewing tobacco (17 percent to 8 percent). Eight percent of Kentucky teenagers report using pain relievers for non-medical reasons in the last 12 months. That's a bit higher than the national average of 6 percent of U.S. teens who report doing the same.

Kentucky's teenagers are also a bit more likely to have had sexual intercourse while in high school (52 to 47 percent) than the national average, more likely to carried a weapon on a least one day (23 percent o 17 percent), carried a gun (9 percent to 5 percent), though less likely to have been in a physical fight (29 to 33 percent).

To find each of these topics, go here. Look for the heading (physical health, mental health, substance abuse, healthy relationships), then go to the Kentucky site page. A more complete data picture will emerge.

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Legislators, doctors debate how health law will or should affect Kentucky; we answer some questions that were left hanging

By Tara Kaprowy and Al Cross
Kentucky Health News

Though host Bill Goodman (above, in an advance promo) said they just "scratched the surface" on what the federal health-care reform law will mean for Kentucky, physicians and legislators debated Medicaid expansion, the implications of requiring people to buy health insurance, how to pay for it all and other questions last night on KET's "Kentucky Tonight" panel and call-in show.

Perhaps the biggest question about the law in Kentucky is whether the state will choose to expand Medicaid, allowing as many as 329,000 more people with incomes up to 138 percent of the federal poverty threshold to qualify for the program for the poor and disabled and be paid for entirely by the federal government in 2014-16. State Rep. Mary Lou Marzian, D-Louisville, pushed hard for the expansion, saying "We can't leave 100 percent of the money laying on the table."

Starting in 2017, the amount of federal contribution will start to decrease — to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and subsequent years, according to the Henry J. Kaiser Foundation.

Kentucky already has a $400 million shortfall in its budget, said Republican state Sen. Tom Buford of Nicholasville, and would need "$515 to $695 million by 2020" to pay for the additional recipients. Other Republicans have said that would require higher taxes or cuts in services, and called for Gov. Steve Beshear to reject the expansion, but supporters of the law argue that the state will save money overall. For that story, click here.

Louisville urologist Michael Macfarlane, a member of the state Republican executive committee, said he would like to see everyone get health care, but "It really boils down to how are we are going pay for this. . . . In every program like this they underestimate what the future entails. . . . The money is not out there. . . . We are going to be Greece and Spain before long."

Marzian replied, "We are paying now for our uninsured folks that we can put onto Medicaid." Noting that the state has spent hundreds of millions of dollars to help the Kentucky Speedway and the Kentucky Horse Park and build the Yum! Center in Louisville, she asked, "Why can’t we help our middle class and the poorest of the poor get health insurance and health care?" She said the law will stimulate the economy because having more people insured will generate more need for health-care services and health-care jobs.

The panel also debated the implications of the law's requirement to buy health insurance or pay a penalty, which the U.S. Supreme Court upheld as a legitimate use of the taxing power of Congress. Marzian said requiring people to buy health insurance is "personal responsibility" since "everybody uses health care at some point."

Buford, an insurance agent and the chairman of the Senate Banking and Insurance Committee, contended that instead of buying health insurance, those not eligible for Medicaid could just choose to pay the penalty ($695 for individuals or up to 2.5 percent of the household income, the Kaiser Foundation notes) and when hospital care is needed, "She can buy insurance on her way in the ambulance," and after being treated, can cancel the policy.

"That is simply not true," Marzian said. "There is a waiting period." Well, not exactly.

Nicole Huberfeld, a University of Kentucky law professor whom Supreme Court Justice Ruth Bader Ginsburg cited in her opinion, told Kentucky Health News, "The law allows for one three-month grace period of non-coverage per year, so if a person were uncovered, then covered, then uncovered, then covered, penalties would be assessed for the second two non-covered periods." She called that scenario "economically inefficient" since "Most people do not choose to pay something, the tax penalty, for nothing: opting not to have insurance coverage."

In his blog for MoneyTalks News, Stacy Johnson argued that buying health coverage only when it's needed might also backfire: "If you go to the emergency room for a broken leg, will you sit there in agony, applying for insurance and waiting as long as it takes for newly purchased insurance to kick in?"

The liveliest debate on the hour-long show was between the two doctors, Macfarlane and Morehead internist Ewell Scott.

Macfarlane said, "This system really has nothing to do with helping people get health insurance, this system is really going to take over health care . . . directly by computer programs and protocols out of Washington," which he said will ration care and socialize the system. He said a new coding system that will require physicians to select from a vast number of codes — up to 68,000 in the new system from 13,000 in the old one, the American Medical Association indicates — to describe in detail the diagnosis and treatment of each case.

Scott replied, "I think Dr. Macfarlane, with all due respect, is crazy. . . . This is not going to happen." Asked is and how Macfarlane was misstating the facts, Scott said, "This is not going to be a problem for the physician." Macfarlane replied, "That's just not true."

The system in question is the International Classification of Diseases. The ninth version of the system has been in place for 30 years. The transition to ICD-10 will be effective Oct. 1, 2013, according to the Cabinet for Health and Family Services. Despite the increased number of codes, it is not expected to be more time-consuming for providers because "each diagnosis or procedure gets only one code," said Don McLeod, spokesman for the federal Centers for Medicare & Medicaid Services.

Scott acknowledged the law is not perfect and "does nothing to control costs in the long run," but called it "a baby step forward for getting us out of this terrible, dysfunctional health-care financing system we've gotten ourselves into." Scott noted the U.S. has the most expensive health-care system in the world "by double" but has "the worst outcomes in the world." A study by The Commonwealth Fund ranked the U.S. sixth of the seven main industrialized countries in terms of quality.

Macfarlane maintained, "We have the best system in the world." He acknowledged changes are needed, but "The idea that the mandate will pay for this is just false." Large swaths of the population, including young adults, undocumented immigrants and people who are out of work, will continue to avoid buying health insurance, he said. (In fact, undocumented immigrants are exempt from paying the penalty, according to the Kaiser Foundation.)

Goodman ended the show by acknowledging the subject's complexity and the need for more discussion on another episode later this summer or in early fall. To view the show, click here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

By Tara Kaprowy and Al Cross
Kentucky Health News

Though host Bill Goodman (above, in an advance promo) said they just "scratched the surface" on what the federal health-care reform law will mean for Kentucky, physicians and legislators debated Medicaid expansion, the implications of requiring people to buy health insurance, how to pay for it all and other questions last night on KET's "Kentucky Tonight" panel and call-in show.

Perhaps the biggest question about the law in Kentucky is whether the state will choose to expand Medicaid, allowing as many as 329,000 more people with incomes up to 138 percent of the federal poverty threshold to qualify for the program for the poor and disabled and be paid for entirely by the federal government in 2014-16. State Rep. Mary Lou Marzian, D-Louisville, pushed hard for the expansion, saying "We can't leave 100 percent of the money laying on the table."

Starting in 2017, the amount of federal contribution will start to decrease — to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and subsequent years, according to the Henry J. Kaiser Foundation.

Kentucky already has a $400 million shortfall in its budget, said Republican state Sen. Tom Buford of Nicholasville, and would need "$515 to $695 million by 2020" to pay for the additional recipients. Other Republicans have said that would require higher taxes or cuts in services, and called for Gov. Steve Beshear to reject the expansion, but supporters of the law argue that the state will save money overall. For that story, click here.

Louisville urologist Michael Macfarlane, a member of the state Republican executive committee, said he would like to see everyone get health care, but "It really boils down to how are we are going pay for this. . . . In every program like this they underestimate what the future entails. . . . The money is not out there. . . . We are going to be Greece and Spain before long."

Marzian replied, "We are paying now for our uninsured folks that we can put onto Medicaid." Noting that the state has spent hundreds of millions of dollars to help the Kentucky Speedway and the Kentucky Horse Park and build the Yum! Center in Louisville, she asked, "Why can’t we help our middle class and the poorest of the poor get health insurance and health care?" She said the law will stimulate the economy because having more people insured will generate more need for health-care services and health-care jobs.

The panel also debated the implications of the law's requirement to buy health insurance or pay a penalty, which the U.S. Supreme Court upheld as a legitimate use of the taxing power of Congress. Marzian said requiring people to buy health insurance is "personal responsibility" since "everybody uses health care at some point."

Buford, an insurance agent and the chairman of the Senate Banking and Insurance Committee, contended that instead of buying health insurance, those not eligible for Medicaid could just choose to pay the penalty ($695 for individuals or up to 2.5 percent of the household income, the Kaiser Foundation notes) and when hospital care is needed, "She can buy insurance on her way in the ambulance," and after being treated, can cancel the policy.

"That is simply not true," Marzian said. "There is a waiting period." Well, not exactly.

Nicole Huberfeld, a University of Kentucky law professor whom Supreme Court Justice Ruth Bader Ginsburg cited in her opinion, told Kentucky Health News, "The law allows for one three-month grace period of non-coverage per year, so if a person were uncovered, then covered, then uncovered, then covered, penalties would be assessed for the second two non-covered periods." She called that scenario "economically inefficient" since "Most people do not choose to pay something, the tax penalty, for nothing: opting not to have insurance coverage."

In his blog for MoneyTalks News, Stacy Johnson argued that buying health coverage only when it's needed might also backfire: "If you go to the emergency room for a broken leg, will you sit there in agony, applying for insurance and waiting as long as it takes for newly purchased insurance to kick in?"

The liveliest debate on the hour-long show was between the two doctors, Macfarlane and Morehead internist Ewell Scott.

Macfarlane said, "This system really has nothing to do with helping people get health insurance, this system is really going to take over health care . . . directly by computer programs and protocols out of Washington," which he said will ration care and socialize the system. He said a new coding system that will require physicians to select from a vast number of codes — up to 68,000 in the new system from 13,000 in the old one, the American Medical Association indicates — to describe in detail the diagnosis and treatment of each case.

Scott replied, "I think Dr. Macfarlane, with all due respect, is crazy. . . . This is not going to happen." Asked is and how Macfarlane was misstating the facts, Scott said, "This is not going to be a problem for the physician." Macfarlane replied, "That's just not true."

The system in question is the International Classification of Diseases. The ninth version of the system has been in place for 30 years. The transition to ICD-10 will be effective Oct. 1, 2013, according to the Cabinet for Health and Family Services. Despite the increased number of codes, it is not expected to be more time-consuming for providers because "each diagnosis or procedure gets only one code," said Don McLeod, spokesman for the federal Centers for Medicare & Medicaid Services.

Scott acknowledged the law is not perfect and "does nothing to control costs in the long run," but called it "a baby step forward for getting us out of this terrible, dysfunctional health-care financing system we've gotten ourselves into." Scott noted the U.S. has the most expensive health-care system in the world "by double" but has "the worst outcomes in the world." A study by The Commonwealth Fund ranked the U.S. sixth of the seven main industrialized countries in terms of quality.

Macfarlane maintained, "We have the best system in the world." He acknowledged changes are needed, but "The idea that the mandate will pay for this is just false." Large swaths of the population, including young adults, undocumented immigrants and people who are out of work, will continue to avoid buying health insurance, he said. (In fact, undocumented immigrants are exempt from paying the penalty, according to the Kaiser Foundation.)

Goodman ended the show by acknowledging the subject's complexity and the need for more discussion on another episode later this summer or in early fall. To view the show, click here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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