Expanding Medicaid will save the state money by eliminating much expense on the uninsured, think tank and op-ed writer argue

If Kentucky chooses to expand Medicaid eligibility up to 133 percent of the federal poverty level, the state will gain in key areas, argues Jason Bailey, director of the Kentucky Center for Economic Policy, right, in an op-ed piece in the Lexington Herald-Leader.

Citing numbers from the Urban Institute, Bailey said the law will provide more than 400,000 Kentuckians with health insurance whether through the expansion of Medicaid or through the state insurance exchange, a number he told Kentucky Health News is a "conservative estimate."

But the kicker is the move will also "result in deep savings in money now spent on the uninsured," he writes. Bailey again quotes from the Urban Institute report, which indicates the state will save between $140 million and $828 million in the first six years of the law in large part because of the decreased use of emergency rooms and because Medicaid will pick up most of the tab for mental health services, which states and local governments mostly shoulder alone.

The Center on Budget and Policy Priorities, though, estimates that states' Medicaid spending will rise by 2.2 percent by 2022 if they decide to expand Medicaid. But that number "actually overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in health-care costs for the uninsured," CBPP spokesperson Shannon Spillane told Suzy Khimm for The Washington Post. "In fact, states could end up with a net gain." (Read more)

If Kentucky chooses to expand Medicaid eligibility up to 133 percent of the federal poverty level, the state will gain in key areas, argues Jason Bailey, director of the Kentucky Center for Economic Policy, right, in an op-ed piece in the Lexington Herald-Leader.

Citing numbers from the Urban Institute, Bailey said the law will provide more than 400,000 Kentuckians with health insurance whether through the expansion of Medicaid or through the state insurance exchange, a number he told Kentucky Health News is a "conservative estimate."

But the kicker is the move will also "result in deep savings in money now spent on the uninsured," he writes. Bailey again quotes from the Urban Institute report, which indicates the state will save between $140 million and $828 million in the first six years of the law in large part because of the decreased use of emergency rooms and because Medicaid will pick up most of the tab for mental health services, which states and local governments mostly shoulder alone.

The Center on Budget and Policy Priorities, though, estimates that states' Medicaid spending will rise by 2.2 percent by 2022 if they decide to expand Medicaid. But that number "actually overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in health-care costs for the uninsured," CBPP spokesperson Shannon Spillane told Suzy Khimm for The Washington Post. "In fact, states could end up with a net gain." (Read more)

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Who is on Medicaid already? Not all poor Kentuckians, foundation president says on op-ed distributed to Kentucky newspapers

By Susan Zepeda
President and CEO, Foundation for a Healthy Kentucky

In the wake of the recent Supreme Court decision upholding much of the Affordable Care Act, states have many factors to weigh. Importantly, SCOTUS affirmed the right of states to opt out of the expansion in Medicaid coverage envisioned under Affordable Care, without penalty. Some state and national leaders have been heard to say that the poor are “already covered under Medicaid.”

Currently, nearly 15 percent of Kentuckians lack health insurance, including approximately 290,000 low-income adults who are uninsured and would be eligible for the Medicaid expansion. It may surprise many to know that about eight out of 10 uninsured Kentuckians are working adults. According to the Kaiser Family Foundation, Kentucky could benefit the most, compared to other states, as a result of the Medicaid expansion — with about 57 percent of our uninsured adults newly eligible for coverage.

While many believe that Medicaid provides coverage for all low-income individuals, Medicaid coverage is actually quite complex, with significant state-to-state variation. In Kentucky:
• Working parents are eligible for Medicaid only if they earn 62 percent or less of the federal poverty level - less than $8,926 per year for a family of two.
• Jobless parents are eligible if their total income is 36 percent or less of the federal poverty level – less than $5,144 per year for a family of two.
• Pregnant women are eligible if their income is up to 185 percent of the poverty level (about $20,665) but lose this eligibility, dropping to the lower income limits above, after the child is born.
• Legal immigrants, child or adult, in the U.S. for less than five years, are not eligible for Medicaid. Undocumented immigrants are not eligible for Medicaid coverage regardless of how long they’ve been in the U.S.

Susan Zepeda

In short, not all Kentuckians living in poverty are covered by Medicaid. If Kentucky does not take the option of expanding Medicaid, many individuals and families living in low-income and poor households will be left without health-insurance access.

The new law also creates health insurance exchanges, and places limits on out-of-pocket expenses on health insurance depending on income level. While these subsidies will allow many low-income parents and individuals to purchase health insurance, they appear only to be available for families above the poverty level.

And other pieces of the law were developed with the assumption that all states would expand Medicaid coverage. Because of this assumption, cuts to other federal health funding are built into the continuing roll-out of the Affordable Care law: For example, nationally Disproportionate Share Hospital (DSH) funding has provided an average of 95 percent of uncompensated care costs for state-owned hospitals; 69 percent of uncompensated care for local public hospitals; and 38 percent of uncompensated care for private hospitals. The law will reduce DSH funding by $14 billion over 10 years, starting in 2014.

This funding decrease to key providers was supposed to be offset by the increase in Medicaid coverage, since the number of uninsured individuals seen at hospitals would drop significantly under the Medicaid expansion. If Kentucky opts out of the Medicaid expansion, however, state, local, and private hospitals could be faced with sharp increases in uncompensated care (care provided but not paid).

The coming months will present opportunities for our state leaders to look at the sometimes difficult health realities of our Commonwealth and make decisions that will best serve the health of all Kentuckians. To quote the late Daniel Patrick Moynihan, “Everyone is entitled to his own opinion, but not to his own facts.”

Susan G. Zepeda is president and CEO of the Foundation for a Healthy Kentucky, a non-profit, non-partisan philanthropic organization that invests in communities and informs health policy through research, education and grant making.

By Susan Zepeda
President and CEO, Foundation for a Healthy Kentucky

In the wake of the recent Supreme Court decision upholding much of the Affordable Care Act, states have many factors to weigh. Importantly, SCOTUS affirmed the right of states to opt out of the expansion in Medicaid coverage envisioned under Affordable Care, without penalty. Some state and national leaders have been heard to say that the poor are “already covered under Medicaid.”

Currently, nearly 15 percent of Kentuckians lack health insurance, including approximately 290,000 low-income adults who are uninsured and would be eligible for the Medicaid expansion. It may surprise many to know that about eight out of 10 uninsured Kentuckians are working adults. According to the Kaiser Family Foundation, Kentucky could benefit the most, compared to other states, as a result of the Medicaid expansion — with about 57 percent of our uninsured adults newly eligible for coverage.

While many believe that Medicaid provides coverage for all low-income individuals, Medicaid coverage is actually quite complex, with significant state-to-state variation. In Kentucky:
• Working parents are eligible for Medicaid only if they earn 62 percent or less of the federal poverty level - less than $8,926 per year for a family of two.
• Jobless parents are eligible if their total income is 36 percent or less of the federal poverty level – less than $5,144 per year for a family of two.
• Pregnant women are eligible if their income is up to 185 percent of the poverty level (about $20,665) but lose this eligibility, dropping to the lower income limits above, after the child is born.
• Legal immigrants, child or adult, in the U.S. for less than five years, are not eligible for Medicaid. Undocumented immigrants are not eligible for Medicaid coverage regardless of how long they’ve been in the U.S.

Susan Zepeda

In short, not all Kentuckians living in poverty are covered by Medicaid. If Kentucky does not take the option of expanding Medicaid, many individuals and families living in low-income and poor households will be left without health-insurance access.

The new law also creates health insurance exchanges, and places limits on out-of-pocket expenses on health insurance depending on income level. While these subsidies will allow many low-income parents and individuals to purchase health insurance, they appear only to be available for families above the poverty level.

And other pieces of the law were developed with the assumption that all states would expand Medicaid coverage. Because of this assumption, cuts to other federal health funding are built into the continuing roll-out of the Affordable Care law: For example, nationally Disproportionate Share Hospital (DSH) funding has provided an average of 95 percent of uncompensated care costs for state-owned hospitals; 69 percent of uncompensated care for local public hospitals; and 38 percent of uncompensated care for private hospitals. The law will reduce DSH funding by $14 billion over 10 years, starting in 2014.

This funding decrease to key providers was supposed to be offset by the increase in Medicaid coverage, since the number of uninsured individuals seen at hospitals would drop significantly under the Medicaid expansion. If Kentucky opts out of the Medicaid expansion, however, state, local, and private hospitals could be faced with sharp increases in uncompensated care (care provided but not paid).

The coming months will present opportunities for our state leaders to look at the sometimes difficult health realities of our Commonwealth and make decisions that will best serve the health of all Kentuckians. To quote the late Daniel Patrick Moynihan, “Everyone is entitled to his own opinion, but not to his own facts.”

Susan G. Zepeda is president and CEO of the Foundation for a Healthy Kentucky, a non-profit, non-partisan philanthropic organization that invests in communities and informs health policy through research, education and grant making.

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Radiology Second Opinion Service Online

How would you or your Doctor like the ability to upload all your radiology exams, including MRIs, CT scans, X-rays, Mammograms and Ultrasounds and receive a detailed second opinion report?

Well, now you or your Doctor can upload your exams conveniently. These reports are prepared by Metis MD board-certified sub-specialized radiologists with 10 years or more experience. Metis MD is an online service providing a second opinion on all your medical imaging.

Because this service is online, it is available to patients anywhere worldwide. Your report will include detailed anatomic descriptions that focus on both the patient's and doctor's specific concerns. These radiology exams are compared with other exams, by experts, making solid recommendations based on correlations between the scans and the patient's medical history. These experts will explain their findings to the patient and/or physician, rating the quality of the scan.

"This service breaks new ground in consumer healthcare" stated Gregory Goldstein, MD, Metis MD founder and president. Dr. Goldstein went on to explain "Giving patients direct access to highly skilled board-certified radiologists has not been done like this before".

Medical imaging plays a key role in medical care and patients have an extremely important say on who and where they receive healthcare from. Patients should receive the very best information in order to, confidently, make the best treatment decisions along with their physicians.

With more and more patients wanting to have more control over final decisions regarding their treatments, Metis MD is giving them the second opinion they are looking for. Second opinions offer patients the power to decide what avenues they have and which ones they wish to take. Metis MD will offer clear, concise findings with expert advice based on the patient's medical history and the findings by the report.

Metis MD will offer you the very best service at very affordable rates, all online. You no longer have to wait for a service to pickup your exams from your Doctor and take weeks to get the results back. Or travel a great distance to sit in a waiting room for hours for a second opinion. Your particular situation is handled with the highest confidentiality and highest expert opinions.

About Dr Kevin Lau

Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.

How would you or your Doctor like the ability to upload all your radiology exams, including MRIs, CT scans, X-rays, Mammograms and Ultrasounds and receive a detailed second opinion report?

Well, now you or your Doctor can upload your exams conveniently. These reports are prepared by Metis MD board-certified sub-specialized radiologists with 10 years or more experience. Metis MD is an online service providing a second opinion on all your medical imaging.

Because this service is online, it is available to patients anywhere worldwide. Your report will include detailed anatomic descriptions that focus on both the patient's and doctor's specific concerns. These radiology exams are compared with other exams, by experts, making solid recommendations based on correlations between the scans and the patient's medical history. These experts will explain their findings to the patient and/or physician, rating the quality of the scan.

"This service breaks new ground in consumer healthcare" stated Gregory Goldstein, MD, Metis MD founder and president. Dr. Goldstein went on to explain "Giving patients direct access to highly skilled board-certified radiologists has not been done like this before".

Medical imaging plays a key role in medical care and patients have an extremely important say on who and where they receive healthcare from. Patients should receive the very best information in order to, confidently, make the best treatment decisions along with their physicians.

With more and more patients wanting to have more control over final decisions regarding their treatments, Metis MD is giving them the second opinion they are looking for. Second opinions offer patients the power to decide what avenues they have and which ones they wish to take. Metis MD will offer clear, concise findings with expert advice based on the patient's medical history and the findings by the report.

Metis MD will offer you the very best service at very affordable rates, all online. You no longer have to wait for a service to pickup your exams from your Doctor and take weeks to get the results back. Or travel a great distance to sit in a waiting room for hours for a second opinion. Your particular situation is handled with the highest confidentiality and highest expert opinions.

About Dr Kevin Lau

Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.

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U.S. Sen. Mitch McConnell speaks at
a Rotary Club meeting in Louisville.
(C-J photo by Michael Clevenger)

With Senate Republican Leader Mitch McConnell calling the federal health-care reform law a tax on the middle class, Courier-Journal Washington correspondent James R. Carroll collects the findings of independent fact-checking services to assess whether McConnell is accurate.

The Congressional Budget Office estimates that 4 million people would pay the tax or penalty for not being covered by insurance in 2016, which translates to about 1.2 percent of the population. But Glenn Kessler of The Fact Checker at The Washington Post, relying on CBO estimates, reported "that 16 million people will receive subsidies or tax credits to help pay for health coverage — about 5 percent of the population."

"It's worth noting that the health law involves more taxes than just a penalty on the uninsured," Kessler notes, including an excise tax on plans with very high premiums; fees for manufacturers and insurers; higher Medicare payroll taxes for people who make more than $200,000 a year; a tax on manufacturers of medical devices; and a tax on indoor tanning services. All told, "it's a stretch to say that any of these taxes will affect the middle class."

McConnell's assertion that President Obama is raising taxes with the individual mandate is also a double-edged sword: a similar penalty was passed with the health-care overhaul in Massachusetts while Republican presidential nominee Mitt Romney was governor. On that point, McConnell said "Romney will have to speak for himself." Last week, Romney said requiring all Americans to buy health insurance is equivalent to a tax, but that ran counter to how he viewed it earlier in the week.

McConnell told the Louisville Rotary Club last week that repealing the law would be his top priority if Republicans win the presidency in November, reports Chris Kenning for The Courier-Journal. (Read more)

U.S. Sen. Mitch McConnell speaks at
a Rotary Club meeting in Louisville.
(C-J photo by Michael Clevenger)

With Senate Republican Leader Mitch McConnell calling the federal health-care reform law a tax on the middle class, Courier-Journal Washington correspondent James R. Carroll collects the findings of independent fact-checking services to assess whether McConnell is accurate.

The Congressional Budget Office estimates that 4 million people would pay the tax or penalty for not being covered by insurance in 2016, which translates to about 1.2 percent of the population. But Glenn Kessler of The Fact Checker at The Washington Post, relying on CBO estimates, reported "that 16 million people will receive subsidies or tax credits to help pay for health coverage — about 5 percent of the population."

"It's worth noting that the health law involves more taxes than just a penalty on the uninsured," Kessler notes, including an excise tax on plans with very high premiums; fees for manufacturers and insurers; higher Medicare payroll taxes for people who make more than $200,000 a year; a tax on manufacturers of medical devices; and a tax on indoor tanning services. All told, "it's a stretch to say that any of these taxes will affect the middle class."

McConnell's assertion that President Obama is raising taxes with the individual mandate is also a double-edged sword: a similar penalty was passed with the health-care overhaul in Massachusetts while Republican presidential nominee Mitt Romney was governor. On that point, McConnell said "Romney will have to speak for himself." Last week, Romney said requiring all Americans to buy health insurance is equivalent to a tax, but that ran counter to how he viewed it earlier in the week.

McConnell told the Louisville Rotary Club last week that repealing the law would be his top priority if Republicans win the presidency in November, reports Chris Kenning for The Courier-Journal. (Read more)

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FDA approves fast, take-home test that detects HIV

A model demonstrates how to use the OraQuick test, which
detects the presence of HIV in saliva.
AP photo by Chuck Zovko.

Soon, taking an HIV test will be no more complicated than swabbing one's mouth and waiting for the results. The Federal Food and Drug Administration last week approved the OraQuick test, which detects HIV antibodies and gives a result in 20 to 40 minutes. 

Orasure plans to start selling the test in October at local pharmacies and online, reports Matthew Perrone for The Associated Press. It is expected to cost less than $60 but more than the one used by health professionals, which costs $17.50.

About 240,000 of the 1.2 million people who are suspected of carrying the HIV virus don't know they are infected. 

The FDA says the test is not 100 percent accurate, but a trial conducted by Orasure showed it only detected HIV in people who have the virus 92 percent of the time. It was 99.9 accurate ruling out HIV in people not carrying the virus. People who test negative should re-test after three months because it can take time for the HIV antibodies to appear. (Read more)

A model demonstrates how to use the OraQuick test, which
detects the presence of HIV in saliva.
AP photo by Chuck Zovko.

Soon, taking an HIV test will be no more complicated than swabbing one's mouth and waiting for the results. The Federal Food and Drug Administration last week approved the OraQuick test, which detects HIV antibodies and gives a result in 20 to 40 minutes. 

Orasure plans to start selling the test in October at local pharmacies and online, reports Matthew Perrone for The Associated Press. It is expected to cost less than $60 but more than the one used by health professionals, which costs $17.50.

About 240,000 of the 1.2 million people who are suspected of carrying the HIV virus don't know they are infected. 

The FDA says the test is not 100 percent accurate, but a trial conducted by Orasure showed it only detected HIV in people who have the virus 92 percent of the time. It was 99.9 accurate ruling out HIV in people not carrying the virus. People who test negative should re-test after three months because it can take time for the HIV antibodies to appear. (Read more)

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Tensions mounting as implementation of prescription drug bill nears on July 20

House Speaker Greg Stumbo, D-Prestonsburg,
sponsored the prescription drug bill.
(Courier-Journal photo)

A controversial bill aimed at curbing prescription drug abuse, which was considered by many as the hallmark of the 2012 General Assembly, is creating tension as its implementation draws nearer. It takes effect July 20.

House Bill 1 puts more restrictions on pain clinics to prevent so-called pill mills from setting up shop in the state. It also requires doctors who prescribe controlled substances to use the state's drug-monitoring system known as KASPER. It further requires licensing boards to set up standards to increase oversight and spell out how doctors should be using KASPER. "But many of the details remain uncertain — including how frequently doctors must run searches of patients — and several areas are poised to drive a wedge between the medical industry and lawmakers in the coming months," reports Mike Wynn for The Courier-Journal.

The Kentucky  Board of Medical Licensure has written a draft proposal with dozens of new rules that have prompted confusion and anger among physicians. House Speaker Greg Stumbo, the bill's sponsor, has questioned the move. "What it appears to me they are doing is almost making it over burdensome to practitioners, and one might argue that is an attempt to make the entire system fail," he said.

Given the anticipated impasse, some expect Gov. Steve Beshear "to sign emergency regulations that will achieve at least some of the goals of HB 1, but those would expire within six months and wouldn't be subject to a prior review process," Wynn reports. (Read more)

House Speaker Greg Stumbo, D-Prestonsburg,
sponsored the prescription drug bill.
(Courier-Journal photo)

A controversial bill aimed at curbing prescription drug abuse, which was considered by many as the hallmark of the 2012 General Assembly, is creating tension as its implementation draws nearer. It takes effect July 20.

House Bill 1 puts more restrictions on pain clinics to prevent so-called pill mills from setting up shop in the state. It also requires doctors who prescribe controlled substances to use the state's drug-monitoring system known as KASPER. It further requires licensing boards to set up standards to increase oversight and spell out how doctors should be using KASPER. "But many of the details remain uncertain — including how frequently doctors must run searches of patients — and several areas are poised to drive a wedge between the medical industry and lawmakers in the coming months," reports Mike Wynn for The Courier-Journal.

The Kentucky  Board of Medical Licensure has written a draft proposal with dozens of new rules that have prompted confusion and anger among physicians. House Speaker Greg Stumbo, the bill's sponsor, has questioned the move. "What it appears to me they are doing is almost making it over burdensome to practitioners, and one might argue that is an attempt to make the entire system fail," he said.

Given the anticipated impasse, some expect Gov. Steve Beshear "to sign emergency regulations that will achieve at least some of the goals of HB 1, but those would expire within six months and wouldn't be subject to a prior review process," Wynn reports. (Read more)

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After losing weight, get the same number of calories from fat and carbs to maintain weight loss, study suggests

Subjects on a low-fat, high-carbohydrate diet did not do
as well when it came to keeping weight off, a study
has found. (Photo by Tetra Images)

All calories may not be equal when it comes to weight loss, the results of a small study show. It found that people who ate a diet of an even amount of carbohydrates and fat were the winners when it came to shedding pounds.

The study, which was published in the Journal of the American Medical Association, involved 21 overweight men and women. After following a 12-week weight-loss regimen in which they lost 10 to 15 percent of their body weight, the subjects were divided into three groups and fed a different kind of diet. One diet was low-fat (60 percent carbohydrates, 20 percent fat and 20 percent protein). A second was low in carbohydrates: 10 percent carbs, 60 percent fat and 30 percent protein. The third was called a "low glycemic index diet," with 40 percent carbs, 40 percent fat and 20 percent protein.

In all three diets, while the subjects were at rest, they burned fewer calories than before they lost weight. "But over the course of the day, the subjects burned more than 300 additional calories on average when on the very low-carbohydrate diet compared with the low-fat diet," reports Eryn Brown for the Los Angeles Times. However, "blood samples drawn from the participants in the low-carb diet phase contained elevated levels of the stress hormone cortisol as well as C-reactive protein, which signals chronic inflammation in the body and has been linked to cardiovascular disease."

Subjects on the low glycemic diet burned 200 more calories than those on the low-fat diet and did not have the problems associated with the high-carb diet, prompting the study's senior author, Dr. David Ludwig, to recommend it as the best course of action. (Read more)

Subjects on a low-fat, high-carbohydrate diet did not do
as well when it came to keeping weight off, a study
has found. (Photo by Tetra Images)

All calories may not be equal when it comes to weight loss, the results of a small study show. It found that people who ate a diet of an even amount of carbohydrates and fat were the winners when it came to shedding pounds.

The study, which was published in the Journal of the American Medical Association, involved 21 overweight men and women. After following a 12-week weight-loss regimen in which they lost 10 to 15 percent of their body weight, the subjects were divided into three groups and fed a different kind of diet. One diet was low-fat (60 percent carbohydrates, 20 percent fat and 20 percent protein). A second was low in carbohydrates: 10 percent carbs, 60 percent fat and 30 percent protein. The third was called a "low glycemic index diet," with 40 percent carbs, 40 percent fat and 20 percent protein.

In all three diets, while the subjects were at rest, they burned fewer calories than before they lost weight. "But over the course of the day, the subjects burned more than 300 additional calories on average when on the very low-carbohydrate diet compared with the low-fat diet," reports Eryn Brown for the Los Angeles Times. However, "blood samples drawn from the participants in the low-carb diet phase contained elevated levels of the stress hormone cortisol as well as C-reactive protein, which signals chronic inflammation in the body and has been linked to cardiovascular disease."

Subjects on the low glycemic diet burned 200 more calories than those on the low-fat diet and did not have the problems associated with the high-carb diet, prompting the study's senior author, Dr. David Ludwig, to recommend it as the best course of action. (Read more)

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