What it's like to lack health insurance, and how health reform is changing that: It's a story for every county, with local data

The Kentucky Standard's Randy Patrick deftly shows how the federal health-care reform law is having an effect at the individual level by telling the story of Bonnie Varnell, a Nelson County resident who is uninsured and is more than $65,000 in debt due to her fight against cancer.

For 18 years, Varnell worked at a daycare that didn't offer health insurance. She wasn't able to buy individual coverage because she had pre-exisiting conditions as a result of surgeries. She is only 59, so does not qualify for Medicare, and she didn't qualify for the federal law known as COBRA, which "allows workers to keep their company group health insurance benefits for up to 18 months after leaving their jobs, as long as they pay the entire premium," Patrick explains.

As a result, the bills kept mounting, despite hospitals giving the Varnells reduced rates through charity care. "I've been trying to pay something on every one," Varnell's husband Ed said of the bills he receives and has to delay paying in full. "It's really frustrating. We had never been late a day in our lives."

Now, Varnell has health insurance through a program created under the Patient Protection and Affordable Care Act. "It costs her $315 a month and covers most of her costs after the deductible is met, but the law stipulates that a person with a pre-existing condition must be uninsured for at least six months before she or he can be eligible," Patrick reports.

Varnell's fear now is the program will be taken away if the Affordable Care Act is repealed after the November election. Patrick gives opponents of the law their say. (Read more)

There are stories like Varnell's in every county. Patrick, who recently joined the Bardstown thrice-weekly after editing papers in Nicholasville and Winchester, sets the bar high for how to tell such stories.

Varnell is among the estimated 15 percent of people in Nelson County who didn't have health insurance in 2009, the last year for which estimates are available. Statewide, the census estimate was 16.5 percent. For a list of all Kentucky county estimates, click here. For the Census Bureau website that is the source of the data, go here. 

The Kentucky Standard's Randy Patrick deftly shows how the federal health-care reform law is having an effect at the individual level by telling the story of Bonnie Varnell, a Nelson County resident who is uninsured and is more than $65,000 in debt due to her fight against cancer.

For 18 years, Varnell worked at a daycare that didn't offer health insurance. She wasn't able to buy individual coverage because she had pre-exisiting conditions as a result of surgeries. She is only 59, so does not qualify for Medicare, and she didn't qualify for the federal law known as COBRA, which "allows workers to keep their company group health insurance benefits for up to 18 months after leaving their jobs, as long as they pay the entire premium," Patrick explains.

As a result, the bills kept mounting, despite hospitals giving the Varnells reduced rates through charity care. "I've been trying to pay something on every one," Varnell's husband Ed said of the bills he receives and has to delay paying in full. "It's really frustrating. We had never been late a day in our lives."

Now, Varnell has health insurance through a program created under the Patient Protection and Affordable Care Act. "It costs her $315 a month and covers most of her costs after the deductible is met, but the law stipulates that a person with a pre-existing condition must be uninsured for at least six months before she or he can be eligible," Patrick reports.

Varnell's fear now is the program will be taken away if the Affordable Care Act is repealed after the November election. Patrick gives opponents of the law their say. (Read more)

There are stories like Varnell's in every county. Patrick, who recently joined the Bardstown thrice-weekly after editing papers in Nicholasville and Winchester, sets the bar high for how to tell such stories.

Varnell is among the estimated 15 percent of people in Nelson County who didn't have health insurance in 2009, the last year for which estimates are available. Statewide, the census estimate was 16.5 percent. For a list of all Kentucky county estimates, click here. For the Census Bureau website that is the source of the data, go here. 

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Raw food diets for kittens–final project report

Final report, Winn grant W09-002
Nutritional adequacy and performance of raw food diets in kittens
Investigators: Beth Hamper, Claudia Kirk, Joe Bartges
University of Tennessee
 
The researchers in this study investigated the effects of raw diets on health and well-being of kittens. While both benefits and costs have been claimed for raw diets, little work has been done on specific effects of the raw diet on cats. In this study, kittens were fed either a commercial processed diet, commercial raw diet, or home-prepared raw diet.

Growth performance was similar on all three diets. Nutritionally, there was neither an advantage nor disadvantage among any of the diets, as all three were nutritionally adequate. The raw food diets were associated with higher digestibility and decreased fecal matter, although a direct health benefit of this difference was not observed. Overgrowth of fecal bacteria was noted in cats fed both control and raw foods. Salmonella spp. was definitively isolated from the feces of one kitten fed the homemade raw diet and undetermined in another instance. Exposure to pathogenic bacteria from raw foods and contaminated commercial diets have been reported in other studies Future research on methods to reduce pathogen load while minimizing processing of animal tissue proteins is recommended. [MK]

Read the interim project report from March 2012

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Final report, Winn grant W09-002
Nutritional adequacy and performance of raw food diets in kittens
Investigators: Beth Hamper, Claudia Kirk, Joe Bartges
University of Tennessee
 
The researchers in this study investigated the effects of raw diets on health and well-being of kittens. While both benefits and costs have been claimed for raw diets, little work has been done on specific effects of the raw diet on cats. In this study, kittens were fed either a commercial processed diet, commercial raw diet, or home-prepared raw diet.

Growth performance was similar on all three diets. Nutritionally, there was neither an advantage nor disadvantage among any of the diets, as all three were nutritionally adequate. The raw food diets were associated with higher digestibility and decreased fecal matter, although a direct health benefit of this difference was not observed. Overgrowth of fecal bacteria was noted in cats fed both control and raw foods. Salmonella spp. was definitively isolated from the feces of one kitten fed the homemade raw diet and undetermined in another instance. Exposure to pathogenic bacteria from raw foods and contaminated commercial diets have been reported in other studies Future research on methods to reduce pathogen load while minimizing processing of animal tissue proteins is recommended. [MK]

Read the interim project report from March 2012

More on cat health:
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New health law and aging baby boomers' anticipated strain on the system is about to make chronic doctor shortage worse

Kentucky's persistent physician shortage is hardly new. Almost a century ago, the Frontier Nursing Service came to Hyden on the presumption that doctors wouldn't. A report from the Health Resources and Services Administration in 2005 found that 81 of 120 of the commonwealth's counties were officially health professional shortage areas. Now comes news that areas in the United States with growing and dense urban populations are feeling the considerable pinch of also not having enough doctors to provide care.

New York Times reporters Annie Lowrey and Robert Pear report that with the expansion of insurance coverage and aging baby boomers driving up demand, we shouldn't expect the shortage to get better anywhere before it gets worse everywhere. (NYT chart)


"The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. That number will more than double by 2025," report Lowrey and Pear. "Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000." In addition, Medicare officials predict their enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year because of the baby boomer demographic hitting their golden years. “Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement. (Read more)

Kentucky's persistent physician shortage is hardly new. Almost a century ago, the Frontier Nursing Service came to Hyden on the presumption that doctors wouldn't. A report from the Health Resources and Services Administration in 2005 found that 81 of 120 of the commonwealth's counties were officially health professional shortage areas. Now comes news that areas in the United States with growing and dense urban populations are feeling the considerable pinch of also not having enough doctors to provide care.

New York Times reporters Annie Lowrey and Robert Pear report that with the expansion of insurance coverage and aging baby boomers driving up demand, we shouldn't expect the shortage to get better anywhere before it gets worse everywhere. (NYT chart)


"The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. That number will more than double by 2025," report Lowrey and Pear. "Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000." In addition, Medicare officials predict their enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year because of the baby boomer demographic hitting their golden years. “Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement. (Read more)

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State insurance exchanges are good for farmers and other rural residents, farmers union president writes

Farmers and rural Americans have much to gain from state health-insurance exchanges under federal health reform, since "Rural residents often have the hardest time getting health insurance," the president of the Wisconsin Farmers Union argues in an op-ed piece in Madison's Capital Times.

People who live in rural areas "are predominantly self-employed and run small businesses, with insurance costs too high because of small risk pools," Darin Von Ruden points out. "They often pay way too much for terrible coverage. Some are uninsurable because of the high-risk nature of farming. Many can't pay high premiums for the current system of individual and family coverage." Insurance exchanges will "broaden risk pools" and bring down the overall cost, he argues. 

Wisconsin has been one of the firmest states against implementing federal health-care reforms, including the exchanges, which will be marketplaces where people can choose from a variety of state-approved health-insurance plans. This month, Republican Gov. Scott Walker said he would not take any action to implement the law until after the November elections. After the U.S. Supreme Court upheld the law, Democratic Gov. Steve Beshear of Kentucky issued an executive order creating a Kentucky exchange. States have the option to run their own exchange or let the federal government do it for them.

Von Ruden said exchanges are "critical" for Wisconsin's farmers and rural communities. "It's disappointing, to say the least, that our legislative majority would be dragging their feet on getting this done," he writes. "I can't imagine why any of them would want to wait on this. Creating our own state exchanges keeps the control in Wisconsin." He concludes, "Every American deserves health care that is comprehensive, affordable and accessible, regardless of occupation or geographic area." (Read more)

Farmers and rural Americans have much to gain from state health-insurance exchanges under federal health reform, since "Rural residents often have the hardest time getting health insurance," the president of the Wisconsin Farmers Union argues in an op-ed piece in Madison's Capital Times.

People who live in rural areas "are predominantly self-employed and run small businesses, with insurance costs too high because of small risk pools," Darin Von Ruden points out. "They often pay way too much for terrible coverage. Some are uninsurable because of the high-risk nature of farming. Many can't pay high premiums for the current system of individual and family coverage." Insurance exchanges will "broaden risk pools" and bring down the overall cost, he argues. 

Wisconsin has been one of the firmest states against implementing federal health-care reforms, including the exchanges, which will be marketplaces where people can choose from a variety of state-approved health-insurance plans. This month, Republican Gov. Scott Walker said he would not take any action to implement the law until after the November elections. After the U.S. Supreme Court upheld the law, Democratic Gov. Steve Beshear of Kentucky issued an executive order creating a Kentucky exchange. States have the option to run their own exchange or let the federal government do it for them.

Von Ruden said exchanges are "critical" for Wisconsin's farmers and rural communities. "It's disappointing, to say the least, that our legislative majority would be dragging their feet on getting this done," he writes. "I can't imagine why any of them would want to wait on this. Creating our own state exchanges keeps the control in Wisconsin." He concludes, "Every American deserves health care that is comprehensive, affordable and accessible, regardless of occupation or geographic area." (Read more)

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Reports show impact of health-care industry in each of Kentucky's 120 counties

It's not often that such detailed data is broken down to the county level, but a new report looks at the economic impact of the local health-care system in each of Kentucky's 120 counties.

The reports, compiled at the University of Kentucky, look at the number of health-care jobs, as well as the revenue and income generated by the local health-care system. In many rural counties, the authors note, health care is the second largest industry, second only to local government.

The most important economic role of the health-care sector is to "keep local health-care dollars at home," the report says. If private insurance, consumer out-of-pocket payments and Medicare and Medicaid transfer payments aren't kept local, an outmigration of health-care services can take place. "This bypass of local health care remains an important issue for many rural health care providers and rural communities."

Conversely, if the local health-care sector can attract patients from outside the area, health care "can act as an export industry," the authors note. Because doctors and other providers can help improve the health and productivity of the local workforce, the health-care sector can also help an area recruit new and retain existing business.

The county reports include a comparison of household income with the state and nation, and indicates how that income is earned. In Boyle County, for example, 55.6 percent was earned through place-of-work earnings, while 22.6 percent was from transfer payments, such as those from Social Security, Medicare and Medicaid. The reports also break down how much income is generated according to industry type, from 2000 to 2008.

Income earned by Boyle County residents working in the health-care sector increased 42 percent in those years, one of the largest areas of gains in the county. In all, health care accounted for 13 percent of industry in Boyle and generated more than $322 million in sales, more than $151 million in labor income and nearly 3,500 jobs in the area.

The report, available here, was compiled by Dr. Alison Davis, director of the Community and Ecomomic Development Initiative in Kentucky, part of UK's College of Agriculture. It was funded by the Foundation for a Healthy Kentucky.

It's not often that such detailed data is broken down to the county level, but a new report looks at the economic impact of the local health-care system in each of Kentucky's 120 counties.

The reports, compiled at the University of Kentucky, look at the number of health-care jobs, as well as the revenue and income generated by the local health-care system. In many rural counties, the authors note, health care is the second largest industry, second only to local government.

The most important economic role of the health-care sector is to "keep local health-care dollars at home," the report says. If private insurance, consumer out-of-pocket payments and Medicare and Medicaid transfer payments aren't kept local, an outmigration of health-care services can take place. "This bypass of local health care remains an important issue for many rural health care providers and rural communities."

Conversely, if the local health-care sector can attract patients from outside the area, health care "can act as an export industry," the authors note. Because doctors and other providers can help improve the health and productivity of the local workforce, the health-care sector can also help an area recruit new and retain existing business.

The county reports include a comparison of household income with the state and nation, and indicates how that income is earned. In Boyle County, for example, 55.6 percent was earned through place-of-work earnings, while 22.6 percent was from transfer payments, such as those from Social Security, Medicare and Medicaid. The reports also break down how much income is generated according to industry type, from 2000 to 2008.

Income earned by Boyle County residents working in the health-care sector increased 42 percent in those years, one of the largest areas of gains in the county. In all, health care accounted for 13 percent of industry in Boyle and generated more than $322 million in sales, more than $151 million in labor income and nearly 3,500 jobs in the area.

The report, available here, was compiled by Dr. Alison Davis, director of the Community and Ecomomic Development Initiative in Kentucky, part of UK's College of Agriculture. It was funded by the Foundation for a Healthy Kentucky.

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Examining a cat mummy

Gnudi G, Volta A, Manfredi S, Ferri F and Conversi R. Radiological investigation of an over 2000-year-old Egyptian mummy of a cat. J Feline Med Surg. 2012; 14: 292-4.

The mummy of a cat was examined radiographically to determine the content and to describe how cats were wrapped and mummified in ancient Egypt. The mummy is part of the Egyptian collection of the National Archaeological Museum in Parma, Italy. From the time of 1350 BC, cats were occasionally buried with their owners. In later dynasties (945-715 BC), many animals were thought to be the embodiment of gods and goddesses. Female cats were believed to represent the goddess Bastet. From approximately 332 to 30 BC, animals were raised near the temples for the specific purpose of being mummified and left at the temple as offerings. This mummy contained the complete skeleton of a 4 to 5-month old cat. Radiology revealed the cat’s body was wrapped to occupy the smallest space possible. This cat mummy was not buried with its owner and most likely it was an offering to the goddess Bastet. It is considered a high quality archeological finding. [VT]

See also: Falke TH, Zweypfenning-Snijders MC, Zweypfenning RC and James AE, Jr. Computed tomography of an ancient Egyptian cat. J Comput Assist Tomogr. 1987; 11: 745-7.

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Gnudi G, Volta A, Manfredi S, Ferri F and Conversi R. Radiological investigation of an over 2000-year-old Egyptian mummy of a cat. J Feline Med Surg. 2012; 14: 292-4.

The mummy of a cat was examined radiographically to determine the content and to describe how cats were wrapped and mummified in ancient Egypt. The mummy is part of the Egyptian collection of the National Archaeological Museum in Parma, Italy. From the time of 1350 BC, cats were occasionally buried with their owners. In later dynasties (945-715 BC), many animals were thought to be the embodiment of gods and goddesses. Female cats were believed to represent the goddess Bastet. From approximately 332 to 30 BC, animals were raised near the temples for the specific purpose of being mummified and left at the temple as offerings. This mummy contained the complete skeleton of a 4 to 5-month old cat. Radiology revealed the cat’s body was wrapped to occupy the smallest space possible. This cat mummy was not buried with its owner and most likely it was an offering to the goddess Bastet. It is considered a high quality archeological finding. [VT]

See also: Falke TH, Zweypfenning-Snijders MC, Zweypfenning RC and James AE, Jr. Computed tomography of an ancient Egyptian cat. J Comput Assist Tomogr. 1987; 11: 745-7.

More on cat health:
Winn Feline Foundation Library
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Lyme disease in Ky. probably more common than reported

Nearly anyone who has spent considerable time in the woods this summer has later discovered they carried a visitor back with them — one the size of a freckle who latches on for dear life. Ticks are not uncommon in Kentucky, though Lyme disease, which is spread through the bite of a black-legged deer tick, is not commonly seen in the state.

But those numbers are likely under-reported, Keiara Carr reports for The Courier-Journal, in part because "Current medical guidelines say the disease is so rare in Kentucky that doctors should look for alternative causes for symptoms that might suggest Lyme disease."

Only five cases were reported in Kentucky in each of the past two years and there was just one case in 2009. But it's likely cases went under-reported because doctors don't give the blood test that diagnoses Lyme. They just don't feel it's necessary given the rarity of the disease in the area, Carr reports.

But Mike Gatton of Louisville knows all too well that it's possible. He got bitten by a tick while mowing his lawn two years ago. He developed a rash on his leg but when he went to the doctor he was tested for a variety of diseases, including West Nile, multiple sclerosis and Lou Gehrig disease, but not Lyme. "I was feeling more and more fatigued. I was having severe headaches. I was really concerned," he said.

When he got another tick bite a year ago and had the same reaction he had to the first bite, he put the tick in a vial and brought it to his doctor, who still dismissed the possibility of Lyme. He is now being treated with antibiotics he takes intravenously.

Symptoms of Lyme disease include fever, headache and fatigue. Sometimes, a rash that looks like a bull's eye around the tick bite can develop. Usually, people get better with large doses of antibiotics. If left untreated, "the infection can be painful and debilitating, causing arthritis or spreading to the heart and nervous system," Carr reports.

Guidelines by the Infectious Disease Society of America "to help doctors decide if a patient is eligible for treatment say the patient should have received the tick bite in an 'endemic area," Carr reports, which makes sense according to Paul Mead, a consulting physician for the Centers for Disease Control and Prevention. "For example, a physician in Africa evaluating a child for fever should have malaria at the top of his list; a physician in Kentucky should not," he said. (Read more)

Nearly anyone who has spent considerable time in the woods this summer has later discovered they carried a visitor back with them — one the size of a freckle who latches on for dear life. Ticks are not uncommon in Kentucky, though Lyme disease, which is spread through the bite of a black-legged deer tick, is not commonly seen in the state.

But those numbers are likely under-reported, Keiara Carr reports for The Courier-Journal, in part because "Current medical guidelines say the disease is so rare in Kentucky that doctors should look for alternative causes for symptoms that might suggest Lyme disease."

Only five cases were reported in Kentucky in each of the past two years and there was just one case in 2009. But it's likely cases went under-reported because doctors don't give the blood test that diagnoses Lyme. They just don't feel it's necessary given the rarity of the disease in the area, Carr reports.

But Mike Gatton of Louisville knows all too well that it's possible. He got bitten by a tick while mowing his lawn two years ago. He developed a rash on his leg but when he went to the doctor he was tested for a variety of diseases, including West Nile, multiple sclerosis and Lou Gehrig disease, but not Lyme. "I was feeling more and more fatigued. I was having severe headaches. I was really concerned," he said.

When he got another tick bite a year ago and had the same reaction he had to the first bite, he put the tick in a vial and brought it to his doctor, who still dismissed the possibility of Lyme. He is now being treated with antibiotics he takes intravenously.

Symptoms of Lyme disease include fever, headache and fatigue. Sometimes, a rash that looks like a bull's eye around the tick bite can develop. Usually, people get better with large doses of antibiotics. If left untreated, "the infection can be painful and debilitating, causing arthritis or spreading to the heart and nervous system," Carr reports.

Guidelines by the Infectious Disease Society of America "to help doctors decide if a patient is eligible for treatment say the patient should have received the tick bite in an 'endemic area," Carr reports, which makes sense according to Paul Mead, a consulting physician for the Centers for Disease Control and Prevention. "For example, a physician in Africa evaluating a child for fever should have malaria at the top of his list; a physician in Kentucky should not," he said. (Read more)

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