Tea Party protesters object to state-run health insurance exchange; leader says if there is one, feds should run it

By Tara Kaprowy
Kentucky Health News

A public meeting in Frankfort to get stakeholders' input about development of a state-operated health insurance exchange Monday was attended by dozens of Tea Party activists taking issue with Gov. Steve Beshear's intention to create it.

"It was absolutely a formal protest," said organizer David Adams, who writes the blog Kentucky Progress and managed Louisville businessman Phil Moffett's campaign for the Republican nomination for governor last year. "We are very, very strongly opposed and we're just getting started with our protest."

Last week, Beshear announced his intention to create a state-run exchange if the Affordable Care Act is upheld in the U.S. Supreme Court. Since 30 million Americans who don't have coverage now would be required to buy insurance under the law's mandate, the exchange would act as a marketplace in which individuals and employees of small business can choose from several plans that have coverage packages pre-approved by state and federal governments. The people buying from the exchange would be given subsidies to help pay their premiums.

States have the option to create their own exchange or have the federal government run one for them. Through February, Kentucky had received nearly $60 million to help set up an exchange, money officials said would be used for planning.

Several major business lobbies have said the state should have its own exchange, but Adams argues that if there is an exchange, the federal government should run it.

"This idea that if the state does it then we have some kind of control is like saying since we run Medicaid, we have control over Medicaid, which is absolutely not the case," he said. "If we have a state-run health insurance exchange, we will run it in the exact way that the federal government wants us to." He said he fears that once a state-run exchange is set up, "when federal funds run out, we'll be responsible for financing it."

"There is a place for helping people who absolutely can't help themselves," Adams acknowledged, but since people with an income of up to 133 percent of the federal poverty level qualify for the exchange, "We've changed the definition of who can't help themselves. We've moved that line way up into the middle class. In every part of life that we've done that, that has been very counter-productive."

Though the Supreme Court's decision about whether to uphold the mandate won't be known until June, Adams said he felt it was necessary to protest Monday's meeting "to demand that the government send back the $60 million and stop any activities of setting up an exchange." "I don't think anybody really believes that we need $60 million in federal grant money to set up a website to help people buy health insurance," he said. "We need to return that money and operate on a more fiscally feasible path."

In response to a question, Adams said the protest was not held to stir anti-Obama sentiment that might help Kentucky Republican candidates in the November elections. He said the insurance exchange is "just the tip of the spear" and that "the best thing we can do in managing our health care problems is stop going in the wrong direction."

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.

Appalachian Regional Healthcare asks federal judge to make managed-care firm keep it under contract

Appalachian Regional Healthcare, a hospital chain in Eastern Kentucky and southern West Virginia, is seeking an emergency injunction by a federal judge ordering Coventry Cares to let its Kentucky members continue receiving services from the hospitals, and to avoid widespread layoffs the chain says will happen if the judge doesn't intervene, reports Bill Estep of the Lexington Herald-Leader. Coventry Cares is one of three state-approved companies to provide managed care services through Medicaid. It said it would cancel its ARH contract after Friday, which would affect about 25,000 Medicaid recipients.

With a few exceptions, Coventry members would lose access to treatment or have to travel long distances to get to other facilities approved by the company, which ARH and officials in affected counties say would be difficult for most because they don't have money or reliable transportation to make the trip. Coventry spokesman Matthew Eyles said the company would continue paying for some services at ARH hospitals, including ob-gyn services to women who are more than 12 weeks pregnant and have a relationship with an ARH doctor.

The state switched to managed-care last year as a way to save money, but as Estep reports, the move has been "rocky." Providers have complained about delayed payments from the companies and their cumbersome pre-approval processes for treatments. ARH sued Coventry and Kentucky Spirit, another provider, claiming the companies owed more than $18 million for services ARH had provided.  Estep notes, "The state allowed another managed care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry, the company said." The company also said the state failed to implement a method to assess risks that would adequately compensate managed-care providers who have more high-risk patients."

ARH and its Coventry patients think the company is trying to get more money out of the state. Many of ARH's patients are covered by Coventry, and ARH spokeswoman said about 300 to 400 jobs would be cut if Coventry cancels its contract. State officials are encouraging continues negotiation between ARH and Coventry. (Read more)

Meanwhile, Bardstown pediatrician and Passport Health Plan board member James Hendrick wrote a letter to the editor of The Courier-Journal offering Passport's services to "help the state get Medicaid back on track." He said he's been very impressed with the nonprofit's "strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality," adding that because Passport is a nonprofit, it's not concerned with appeasing shareholders. Passport has been managing Medicaid in the Louisville region for several years.

University of Louisville delays choosing hospital partner

To allow time for more "discussions and negotiations," the University of Louisville has put off deciding on University Hospital's new health-care partner until the end of June.

It is not known how many entities are interested in partnering with the indigent-care hospital, nor have any entities been identified. The deadline for applications, which was last month, has not been extended. "The university has said it needs a partner with deep pockets that can inject cash required to expand the hospital and attract new patients," reports Andrew Wolfson for The Courier-Journal.

Kerri Richardson, chief spokeswoman for Gov. Steve Beshear, said he is hopeful the hospital will find "a suitable path forward to preserve its public mission and continue to successfully serve citizens in the region."

Last year, Beshear rejected a proposed merger between University Hospital, Jewish Hospital & St. Mary's HealthCare and Saint Joseph Health System, which is owned by Catholic Health Initiatives. Because Saint Joseph would have had majority control in the initial deal, the other facilities would have had to adhere to Catholic health directives, which affect procedures like elective abortions, sterilizations, artificial insemination and euthanasia. Those limitations raised concerns and that the move would have been a loss of control of a public asset, meaning University Hospital.

After Beshear's decision, Jewish & St. Mary's and St. Joseph merged, forming KentuckyOne. (Read more)

Obama finally embraces the Republican term 'Obamacare'

“The Obama administration made a decision on Friday to own the term‘ObamaCare’,” NBC News reports in its First Read blog, adding a capital letter not often used. “It had been used as a pejorative by Republicans, but the White House has made the decision to embrace it and not let opponents have a word that they only drive as a negative. White House senior adviser David Plouffe noted on ‘Meet the Press’ Sunday that, in 10 years, health care will be a positive and cited polling that people don’t want to re-litigate it. We can report that last part came from Democratic polling Plouffe has seen; he was not citing any public polling on this specific issue.”

The NBC item is also based on a story yesterday from The New York Times, which reported that Democrats are “launching a Twitter campaign that seeks to build positive associations for it.” The Twitter post read, “If you’re proud of Obamacare and tired of the other side using it as a dirty word, complete this sentence: #ILikeObamacare because ...”

The story noted that “Obamacare” has been used “primarily by Republicans, as a term of disdain. Democrats have tried to limit the term’s use to reshape perceptions, but that has been a tough sell.” The Times quotes Grant Barrett, a vice president for the American Dialect Society, who said that once a word becomes political, it is very difficult to quash it: “It’s an invitation to have your heart broken. You forbid it, and they start writing it on the bathroom stalls.”

For the Times story and a nice graphic showing the history of the term, and examples of its use, by Amanda Cox, Alicia DeSantis, Alicia Parlapiano and Jeremy White, click here.

Beshear talks to University Hospital officials about future

Gov. Steve Beshear met with officials with University Hospital officials yesterday to discuss ways the facility can take part in a merger. Last week, Beshear rejected a much-publicized proposal that would have unified University Hospital with Jewish Hospital & St. Mary's HealthCare and Saint Joseph Health System, which is owned by Catholic Health Initiatives.

Beshear called the meeting "productive" and said he would get back to officials next week, reports Patrick Howington of The Courier-Journal.  "We remain committed to supporting University Hospital in reaching our common goals of care for our most vulnerable citizens while maintaining sound financial footing for the institution," Beshear said. James Taylor, CEO of University Hospital, declined to go into detail about the one-hour meeting.

Because Saint Joseph would have had majority control in the initial deal, the other facilities would have had to adhere to Catholic health directives, which affect procedures such as elective abortions, sterilizations, artificial insemination and euthanasia. Those limitations raised concerns, and Beshear said his major reservation was that the move would mean "the loss of a control of a public asset," meaning University Hospital.

Hospital officials said earlier this week they will continue to work together to put together a proposal that Beshear "would feel compelled to approve,'" reports Laura Ungar of The Courier-Journal. "The jockeys are not changing right now," University Hospital spokesman David McArthur told her. CHI spokeswoman Mary Elise Beigert said her company "is evaluating potential options." Jewish & St. Mary's officials had no comment. (Read more)

In an editorial, The Courier-Journal applauded Beshear's decision to reject the merger. "Gov. Beshear and the Attorney General [Jack Conway] both hit the nail right on the head," the paper said. "It's time to drop this misbegotten merger effort, and seek other ways to strengthen the local hospitals." (Read more)

Beshear may need to support meds-for-meth bill for it to pass, Conway says

Passage of a "meds-for-meth" bill next year could depend on how a re-elected Gov. Steve Beshear feels about the issue, on which he has not taken a position, Attorney General Jack Conway told Ryan Alessi on CN|2's "Pure Politics."

Conway is a supporter of such a bill, which would make pseudoephedrine, a key ingredient in the manufacture of methamphetamine, available only by prescription. Alessi noted that the Democratic governor has remained ambivalent about the issue and asked the Democratic attorney general, "Does the governor need to come out in order to get something like that passed?"

"This is an issue ... that just grabbed me, right here."

Conway replied, "He may need to. He may need to, and I know he's studying the issue." Bringing his hand to his chest, Conway continued, "This is an issue, Ryan, that just grabbed me, right here," adding that he had been wrongly blamed during his U.S. Senate race last year for an increase in meth labs during his term."We have seen an explosion of meth labs in this state for two reasons," he said. "One, it's still very easy to get your hands on pseudoephedrine, and . . . you now can do it in a mobile fashion ... called a shake-and-bake lab." He said U.S. Rep. Hal Rogers, R-Somerset, begged him to support the bill partly because investigators for the UNITE anti-drug program Rogers started are having to shift from prescription drugs to meth.

Conway said he would be open to changing his position if drug companies and other opponents of the bill can come up with a way to control "smurfing," the use of surrogates to circumvent the electronic system that tracks pseudoephedrine purchases but is not even used by most pharmacies.

His Republican opponent, Hopkins County Attorney Todd P'Pool, opposes the bill and says meth manufacture should be controlled by tightening "the law to bar convicted drug dealers from being able to buy cold medicine with pseudoephedrine and cracking down on the amount someone can buy per month," Alessi reports. (Read more, view interview with Conway)

State officials step up efforts against prescription drug abuse, targeting doctors

By Tara Kaprowy and Al Cross
Kentucky Health News

LEXINGTON — Targeting what Gov. Steve Beshear called "drug dealers in white coats" is the goal of a new effort against prescription drug abuse in Kentucky, which is killing more Kentuckians than traffic accidents.

State Sen. Robin Webb, D-Grayson, speaks after
Stumbo, Beshear and Conway at press conference.

Announced by Beshear, Attorney General Jack Conway and House Speaker Greg Stumbo at a Lexington press conference, the plan is designed to root out doctors with suspicious prescription practices and pass legislation to better track prescriptions.

Most of the effort is aimed at improving and expanding use of the Kentucky All Schedule Prescription Electronic Reporting system, which relatively few physicians use to see if patients are doctor-shopping for painkillers. An advisory board of physicians, dentists, nurses and pharmacists will work with KASPER officials and law-enforcement agencies to define acceptable prescribing practices in different medical disciplines. Suspicious activity would be reported to the respective licensing boards.

In August, Stumbo grilled the Kentucky Board of Medical Licensure about why it wasn't increasing its oversight on doctors since it had asked for the authority to analyze KASPER data. Lloyd Vest, the licensing board's general counsel, said the data were not specific enough. Stumbo said yesterday, “The problem is how you define what over-prescribing is.” That's what the advisory board will do.

Beshear, asked how soon he would expect an enforcement action to result from the process described, he said he would “push them to move very fast." Other boards handle licensing for dentists, nurses and pharmacists.

Beshear said he wants all physicians to be part of KASPER, especially those who prescribe scheduled narcotics such as oxycodone. Asked about the cost to doctors and patients, he said, "Kentucky will absorb whatever cost." When pressed he said, "We'll handle our part of it and I'm sure the medical profession will hold up their end of it."

Conway said only about 25 percent of physicians use KASPER, but many don't prescribe painkillers. He said the system "takes 10 or 15 seconds" to use but should be made more user-friendly. He said there is a special concern about emergency-room physicians because "a lot of people who are shopping for pills are going to emergency rooms."

Beshear said Operation UNITE, a federally funded anti-drug program in Eastern Kentucky, has received a $600,000 grant from the Appalachian Regional Commission to conduct an education program for about 1,000 physicians and drug dispensers about the dangers of prescription drug abuse and the benefits of KASPER.

Stumbo said Oklahoma recently found 80 percent of its drug overdoses were from prescription drugs and Kentucky would find "exactly the same" if it did the same study. "It's not the drug dealers that are killing our kids, it's the drug-dealing doctors," he said.

Conway said he asked a group of Eastern Kentucky students if they had taken a prescription drug for reasons not listed on the pill bottle and 75 to 80 percent raised their hands. He said the same number said prescription drugs are easy to obtain, and none said their parents lock the medicine cabinets at their homes.

Stumbo, a Prestonsburg lawyer who preceded Conway as attorney general, said the trend reports from KASPER have shown pill abuse leveling off in Eastern Kentucky but rising in places outside the region, and gave Marion County and the Jackson Purchase as examples.

Beshear and Conway are running for second terms in the Nov. 8 election, but Stumbo said the effort is non-partisan and Republican Sens. Jimmy Higdon of Lebanon and Robert Stivers of Manchester are also working on it. They did not attend the press conference, but Higdon said in an interview that he will pre-file a bill require pain clinics to be appropriately licensed and run by physicians who pass background checks.

Also invited but not present was Sen. Tom Jensen, R-London, who is exploring the possibility of again introducing a bill that would make pseudoephedrine, the key ingredient for making methamphetamine, available only by prescription. Beshear, who declined to take a position on that, said he is "committed to finding an answer" to the problem but it does not have the sort of consensus that the prescription drug-abuse issue has.