- Associated Press - Wednesday, August 3, 2016

Recent editorials from Kentucky newspapers:

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Aug. 2

Lexington Herald-Leader on using Medicaid to build the workforce:

It’s hard to find a more complicated thicket than health care finances, yet there are some clear truths: We all end up paying for each other’s health care. The best way to control costs is to prevent disease and expensive medical crises.

With that in mind, dividing Kentuckians covered by taxpayer-funded Medicaid from those covered by taxpayer-subsidized private health insurance, as a Bevin administration spokeswoman seemed to do last week, sheds no light. It does stigmatize as “dependent” people who toil for low wages with only Medicaid to keep them healthy.

In the view of the Bevin administration, which is seeking to erect new obstacles to Medicaid coverage, the dramatic decline in uninsured Kentuckians does not count because 440,000 of our neighbors gained access to preventive care through expansion of the federal-state Medicaid program.

As 31 states have now done, Gov. Steve Beshear used the Affordable Care Act to expand Medicaid eligibility to people making up to 138 percent of the poverty level (that’s $16,394 a year for a childless adult). Kentucky’s uninsured rate for the non-elderly fell from 18.8 percent in 2013 to 6.8 percent in 2015, one of the largest drops in the country, according to the Kaiser Commission on Medicaid and the Uninsured.

Last week, a Bevin administration spokeswoman told The Courier-Journal: “There has not been a historic drop in uninsured - this is misleading” and that “Medicaid is not health insurance - it is a benefit program like SNAP (food stamps) or TANF (Temporary Assistance for Needy Families). … What we have seen is a historic rise in people on taxpayer-funded Medicaid.”

The implication is that people who enroll in Medicaid because their employers don’t provide health insurance or they can’t afford it are sponging off taxpayers, while people who have private insurance through their employers or individual policies are pulling their own weight.

In fact, the federal government heavily subsidizes private health insurance through tax deductions. The largest break in the entire tax code is the $250 billion annual exclusion of employer-paid health insurance premiums from income and payroll taxes, reports the Tax Policy Center. Workers pay federal taxes on their wages and salaries but not on health care benefits that are part of their compensation. Because this break reduces taxable income, it’s worth more to higher earners.

Among government expenditures for health care, only Medicare and Medicaid exceed the tax deduction for employer-sponsored health plans. Health care premiums paid by self-employed people and other individuals also may be deductible.

In addition to taxpayer subsidies and funding for programs like Medicare and Medicaid, we also pay for each other’s health care when hospitals charge more to make up for losses from patients who cannot pay. Kentucky hospitals have enjoyed a steep decline in uncompensated care since the Medicaid expansion, while emergency room misuse is showing signs of decline as more people gain primary care. The state has a long way to go, but trends are encouraging.

Gov. Matt Bevin’s goal of using taxpayer subsidies to move people from Medicaid into employer-sponsored plans is probably unrealistic because many low-wage employers offer no health coverage. The governor also wants Medicaid recipients, even those earning less than $11,000 a year, to pay premiums or co-pays, although research shows they will opt to go without preventive care and medicines.

Look only to London (the Laurel County seat, not the British capital) for a better model. The Laurel Grocery Co., a wholesaler operating in nine states, is saving money and increasing productivity not, as Bevin proposes, by making its 250 employees pay more, but by making primary care more accessible. A workplace clinic and free generic prescription drugs, such as blood pressure and diabetes meds, are producing a healthier workforce.

Rather than trying to save money by excluding people, Bevin should leverage Medicaid to produce a healthier workforce. For every $1 the state spends on the Medicaid expansion, the federal government will kick in $9 to help one of the poorest, sickest states get healthier.

The administration, which has pushed back its self-imposed Aug. 1 deadline for finalizing its Medicaid proposal to make adjustments in response to public feedback, should keep in mind what Laurel Grocery CEO Winston Griffin says: “We’re all in this together.”

Online:

http://www.kentucky.com/

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July 31

The Daily News on the Feeding America program in Warren County:

It cannot be said enough that no one in this country should have to go through their days without being fed. As the richest country in the world, there is absolutely zero excuse for there to be hungry people in the United States.

Thankfully, there are organizations in our city and cities across the country that make sure no one goes without food.

In Bowling Green, we are fortunate to have Feeding America Kentucky’s Heartland partnering with The Salvation Army to offer Warren County residents food the last Wednesday of each month to help decrease food insecurity in the state. One of the reasons for the event, besides feeding those in need, is that Feeding America has never been able to get enough charitable food because their pantry base isn’t large enough here. So, they decided to do this mass distribution of food each month.

Sadly, nearly one in six Kentucky residents and one in four children live in households that can’t always afford food.

These are scary statistics that must change.

Events like this one have the real potential to do just that.

Last week, hundreds of people lined up in the parking lot of Family Dollar on Glen Lily Road for the first distribution of commodity supplemental food boxes and fresh fruits and vegetables, milk, juice, bottled water, bread and other items from the Farm to Food Banks program. Officials with Feeding America said it brought 25,000 pounds of food, with 9,000 pounds of it being produce. He said the amount of food brought should serve around 800 families.

Recipients who haven’t received a food box from the United State Department of Agriculture in the last 30 days also had the opportunity at the event to pick up peanut butter, dried beans, canned fruit and boxed mashed potatoes.

This really is a great program. People who normally could be missing meals are now receiving food. This event helps those who are barely getting by and those who are without homes. Our hats go off to these organizations and the volunteers who helped and will continue to help with this event because through their noble efforts they are making a real difference in people’s lives.

Online:

http://www.bgdailynews.com/

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July 29

The Courier-Journal on preventing HIV outbreaks:

A Wall Street Journal map based on data from the Centers for Disease Control and Prevention is telling. Large swaths of Kentucky - 54 of 120 counties - are red. Southern Indiana also is scarred by several red counties.

The red on the map identifies the counties that the CDC says are at high risk of outbreaks of HIV and hepatitis C among injection drug users. The CDC identified at-risk counties by analyzing data such as unemployment rates, overdose deaths and sales of prescription painkillers.

The CDC’s analysis is aimed at heading off another outbreak of disease such as that which afflicted the area around Scott County, Indiana, last year, leaving 181 people HIV positive. The CDC has warned Kentucky, Indiana and 24 other states to step up testing and be ready to deal with an outbreak.

As it happens, the CDC warning in June was followed last week by a New England Journal of Medicine study that said the southeastern Indiana outbreak could have been avoided. The study suggests that Indiana and other largely rural states such as Kentucky should focus on prevention measures - more HIV testing, identifying networks of intravenous drug users, increasing access to treatment, syringe-exchange programs and education. Of course, reducing addiction also would play a role.

It’s time for states to heed such calls. Most important, states need to clear the hurdles that still exist to setting up needle-exchange programs, especially now that a recent change in federal policy allows the use of federal funds to run such programs, though not to pay for the syringes.

As part of a major heroin bill that passed the Kentucky General Assembly in 2015, local jurisdictions are allowed to set up syringe exchanges at their discretion. So far, only Louisville and Lexington have done so. Others, no doubt, are held back by doubters who say handing out syringes only encourages drug abuse.

Now, some in the commonwealth are battling over whether such programs should provide only one syringe for each one turned in. The problem is that exchanging needles one-for-one assumes that the needle isn’t being shared and the clean needle isn’t just going back to being shared. Some argue that requiring a needle be turned in helps encourage users not to discard needles carelessly. Still, getting a clean needle in the hands of each drug user should be the primary goal.

In Indiana, the law passed there requires a local government to declare a public health emergency and prove that HIV, hepatitis C or overdose deaths are on the rise before it can set up a needle exchange. As the CDC warning should make clear, reacting after a scourge has taken hold is too late.

Clark County, Indiana, has been waiting almost a year since local elected officials decided a needle exchange was an appropriate part of a comprehensive approach to preventing an HIV outbreak and helping curb drug abuse. Clark County has high overdose death rates (higher than Jefferson County’s per capita) and hepatitis C has been on the rise. Yet, for some unknown reasons, Clark’s application has been held up at the state level.

In addition to the benefits of reducing the spread of disease, needle exchanges also offer an opportunity for some addicts to get connected with treatment when they come forward to get clean needles.

Now is the time to keep moving ahead on all fronts - but especially needle exchanges - to prevent the spread of disease. Kentucky and Indiana have too much at risk.

Online:

http://www.courier-journal.com/

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