Ben Chandler, who as AG filed lawsuit that led to creation of Foundation for a Healthy Kentucky, will be its president and CEO

Ben Chandler (AP photo)

Ben Chandler, who as state attorney general filed the lawsuit that led to the creation of the Foundation for a Healthy Kentucky, was named president and CEO of the foundation Monday.

Chandler, 56, was state auditor in 1992-95, attorney general in 1996-2003 and Sixth District representative in Congress from 2004 to 2012, when he lost a bid for re-election. He lives near Versailles and has been executive director of the Kentucky Humanities Council.

As attorney general in 1997, Chandler sued Anthem Blue Cross Blue Shield of Kentucky to recover the charitable assets Anthem received after merging in 1993 with non-profit Blue Cross. In 1999 Anthem Inc. agreed to put $45 million into an independent, charitable foundation that would address the unmet health needs of Kentuckians. The Foundation for a Healthy Kentucky was created and had its first board meeting in 2001.

Chandler succeeds Susan Zepeda, who has been president and CEO since 2005 and announced last year that she would retire at the end of the year. Zepeda came to Kentucky after serving as CEO of The HealthCare Foundation for Orange County in California, and before that as head of the health agency and hospital in San Luis Obispo County.

Chandler said in a press release, “Having fought so hard for a healthier Kentucky during my time as attorney general, I am beyond thrilled to be invited to build on the good work of Susan Zepeda and her team and to lead the foundation to even greater impact. The health challenges in our state are very real, but so is the commitment to a healthier future for all our citizens.”

Foundation Board Chair Chris Roszman, who chaired the search committee, said, “Ben’s past experiences as a bipartisan leader in championing health policies through collaboration and effective consensus-building will serve the foundation well as we continue to address the unmet healthcare needs of Kentuckians.”

Search committee member Robert Slaton, a former state health commissioner who chairs the foundation’s Community Advisory Committee, said in the release, “Sixteen years ago Ben had a vision. To welcome him to continue that vision today is very exciting.”

The nine-member search committee consisted of business and health leaders from across the state, the press release said. All were current or former members of the board or the Community Advisory Committee. "In an extensive, six-month process, the search embraced a broad array of potential contenders from across the commonwealth and from 21 other states and the District of Columbia," the release said.

Chandler earned both his B.A. and J.D. degrees from the University of Kentucky. He studied at the University of London and Trinity College in Dublin, including an internship in the British Parliament. He practiced law with Brown, Todd & Heyburn, specializing in health-care law, and later with Reeves & Graddy in Versailles. He and his wife, Jennifer, have three children, live on the family farm and attend Pisgah Presbyterian Church, where he is a trustee.

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If you read a story saying pasta isn't fattening and can help you lose weight, you may not have gotten the whole story

By Steve Wilson
The Paducah Sun

Newspapers are often faulted for not printing enough good news, and a reader lodged a fresh complaint along that line last week.

"Why didn't you have a story about the study that found eating pasta is good for you? TV had it, and it was all over social media. We spaghetti lovers would appreciate reading something good about a food that's gotten a lot of criticism."

I said I hadn't heard about the study and would look into it. What I learned is that despite all the cheerful sound bites and headlines it generated ("Pasta isn't fattening and can help you lose weight") the study provides a prime example of how slapdash reporting can mislead more than inform.

It's no mystery why the study was widely reported, especially by media that are fond of "click bait" and measure success by the number of eyeballs they attract online.

Pasta sales have dropped in the past decade as low-carbohydrate diets have gained favor. Many nutritionists disparage the food as "empty calories" without much benefit, especially for people wanting to lose weight. . . . 

Buried far down in a couple of the stories were these facts:

• A traditional serving of pasta in Italy is no more than three ounces, far smaller than what most people eat in the U.S., and less likely to have a high-calorie sauce. It's usually served as a light first-course.
• Italians in the study were likely to follow the healthful Mediterranean diet, which is rich in olive oil, fish, fresh fruits and vegetables and whole grains.
• Italian pastas have more whole grains than most American white-flour varieties. They're higher in nutrients and fiber, making them beneficial in giving a sense of fullness that helps control calorie intake.
• The study was partly funded by Barilla, a leading pasta-maker.

. . . While the Italian study is less than a ringing endorsement for filling up on pasta, it's good to see evidence that moderate consumption is healthy and can even help people lose weight.

What's unhealthy are media reports that skim the surface of a study and misrepresent its findings.

This is a condensed version of the article. The full version is here but behind a paywall.

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Needle exchanges slowly spread as locals conclude they're better than HIV and hepatitis outbreaks, injuries from discarded syringes

Needle exchanges may be difficult for some people to accept, but they are better than outbreaks of hepatitis and HIV or accidental injury from discarded needles, officials in Kentucky counties that have established the exchanges told Bill Estep of the Lexington Herald-Leader.

"Programs allowing intravenous drug users to exchange dirty syringes for clean ones are spreading in Kentucky as communities confront growing heroin abuse and concerns over the potential for disease outbreaks caused by addicts sharing needles," Estep reports. "So far, health departments and local governments in 13 counties have approved needle exchanges, and 11 are in operation, according to the state Cabinet for Health and Family Services and local officials."

Kentucky leads the nation in hepatitis C cases and has 54 of the 220 counties that the federal Centers for Disease Control and Prevention considers most at risk for HIV or hepatitis outbreaks from shared needles, based on "statistics such as numbers of overdose deaths, per capita income, unemployment and sales of painkillers," Estep notes. "Kentucky had 18 counties that the CDC calculated to be more vulnerable than Scott County, Indiana, to a disease outbreak among IV drug users, with Wolfe County considered at greatest risk in the nation."

A version of this map appeared on Kentucky Health News May 5. This one adds needle-exchange sites.

Some local officials "said they’ve faced concerns that giving needles to drug users enables or condones illegal drug activity, or will make the local drug problem worse," Estep reports. Republican Judge-Executive Mike Malone of Carter County "said he shared those concerns when officials from the health department brought up the idea. Malone said he changed his mind because of the potential for the program to head off disease and get addicts into treatment.

“It’s not about enabling them to take drugs. It’s about stopping the spread of disease,” Malone said. “The more you learn about it, the more you’ll understand it’s the right thing to do.”

Estep reports, "Health officials said they understand some people don’t like the idea of providing drug users with needles at public expense, but they argue the potential cost to taxpayers of not doing so is far worse."

Needle exchanges are operated by local health departments with approval of the county health board, the fiscal court and the city where the exchange is located, under a law passed by the 2015 General Assembly.

UPDATE, July 22: "Clark County’s needle exchange opened a week ago with one client." Fred Petke reports for The Winchester Sun. "Local officials are good with that." Clark County Health Department director Scott Lockard told Petke in an email, “Some of the health departments had their exchanges open several weeks before having their first client.”

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Appalachian Health and Well-Being Forum to be held at extension office in Whitesburg Monday evening, July 25

A July 25 forum in Whitesburg will give residents of southeastern Kentucky a chance to tell four health experts their concerns about health issues and possible solutions, and share success stories and plans for future work.

The Appalachian Health and Well-Being Forum will be held from 6:30 to 8 p.m. at the Letcher County Cooperative Extension Office at 478 Extension Drive.

Dr. Linda Birnbaum

Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences, will join a panel of local community and health leaders who will highlight model programs and activities, then hear from the audience. The program is sponsored by NIEHS and the University of Kentucky.

Others on the panel will be Mike Caudill, CEO of Mountain Comprehensive Health Corp. in Whitesburg; Dawn Brewer, assistant professor in UK's Department of Dietetics and Human Nutrition; and Fran Feltner, director of UK's Center of Excellence in Rural Health in Hazard.

The forum will also include a variety of exhibitors who will share information about health-related programs and activities in the area. It is designed in part to connect individuals and groups working in overlapping areas to improve the overall health and well-being of Eastern Kentucky.

“Too often, individuals and organizations work in overlapping areas to promote positive lifestyle behaviors but are not fully aware of each other's work. This forum will provide an important opportunity to build such awareness across the region, with participants sharing and learning from each other,” said UK professor Lindell Ormsbee, who has received many NIEHS grants. He led a team of community members in Perry and Letcher counties, plus UK faculty and students, in planning the event.

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Some comments on Medicaid plan will be adopted, and federal officials will approve revised plan, state officials say on KET

L-R: Host Bill Goodman, Brinkman, Glisson. (KET photo)

By Al Cross
Kentucky Health News

Some of the comments about proposed changes in the state Medicaid program will be included in an "improved" plan to be submitted to federal officials in about two weeks, Health Secretary Vickie Yates Brown Glisson said Sunday on KET's "One to One."

"We got some great comments; we got some very thoughtful comments" on ways the plan can be improved, Glisson said. "We are anxious to take some of those comments and incorporate them." She did not elaborate.

Glisson and State Cabinet Secretary Scott Brinkman also touched on what they said were some misconceptions about the plan – which Gov. Matt Bevin has proposed to reduced costs and increase involvement of Medicaid recipients who are covered by the 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty threshold.

For example, Brinkman said the proposed removal of dental and vision services applies only to adults in the expansion population who are not medically frail. "We're very comfortable with that decision," he said. Such recipients could earn dental and vision care by doing such things as taking a health literacy course.

The plan also requires able-bodied adults who are not primary caregivers of a dependent to have a job, look for one, take job training or do volunteer work. "We're talking about volunteerism," Brinkman said. "We know that once people are engaged they tend to grow in self-esteem, self-satisfaction" and have better lifestyles.

Glisson said the rule would apply to 215,000 people, "a very small segment" of the overall Kentucky Medicaid population of 1.2 million. The expansion population is about 430,000, so the rule would apply to about half of those in the expansion.

The plan would require almost all Medicaid recipients to pay premiums of $1 to $15 a month, another feature that has brought objections from the poor and their advocates. Brinkman said $180 a year for people above the poverty line "is a pretty good deal."

Glisson said advocacy groups "didn't care so much for the co-pay system," now in place for traditional and expansion Medicaid, and "liked the idea of a cost sharing being more like a premium. . . . It's very budgetable."

Managed-care companies that handle Medicaid have been waiving the co-payments, primarily as a way to get Medicaid recipients to choose them, but state officials have said they will stop that.

Glisson said traditional Medicaid recipients who don't pay premiums would be required to make co-payments. Expansion recipients who failed to pay would be dropped from the system but could get back in if they paid up and took a financial- or health-literacy course.

Some critics of the plan have said it is designed to be rejected by federal officials, allowing Bevin to return to his initially stated campaign goal of abolishing the expansion. Brinkman denied that and said he was "convinced" that the Centers for Medicare and Medicaid Services will approve the revised request for a waiver of federal rules to allow the plan to proceed.

"There are some things they have not approved in the past [in other states] but they haven't been structured like they have been" in Kentucky's plan, Brinkman said. "At the end of the day I'm convinced CMS will see that and approve our waiver."

The comment period on the initial plan ends at 5 p.m. ET July 22. Comments can be emailed to kyhealth@ky.gov. "Please write and give us your comments and your thoughts," Glisson said. "We would really welcome that."

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House Task Force on Vulnerable Kentuckians hears complaints about proposed changes to Medicaid program

By Melissa Patrick
Kentucky Health News

BEATTYVILLE, Ky. – Several speakers at the July 15 meeting of the House Task Force on Vulnerable Kentuckians said Gov. Matt Bevin's proposed changes to the Medicaid program would be too complicated for the most vulnerable Kentuckians and will create barriers to care on several fronts.

Mary Mead-McKenzie, executive director of the Kentucky River Community Center, which offers behavioral and addiction services to eight of Kentucky's poorest counties, said the work-or-volunteer requirements for able-bodied adults who aren't primary caregivers of dependents are not feasible in areas where there are no jobs. "Are we going to say that we are going to punish you because of the economy?" she asked.

Mead-McKenzie also opposed the proposed monthly premiums for most Medicaid recipients that would initially range from $1 to $15 per person. She painted a picture of what coming up with an extra dollar means for many of the families she serves.

"A dollar is a lot to some people," she said. "Look at people who have to dig in their cushions to get enough money to buy one gallon of gas to get to work and back . . . and then you add on a $5 premium. . . . Yes, it does impact people and these are the most vulnerable people in our state."

The bipartisan task force, formed by House Speaker Greg Sumbo, D-Prestonsburg, will hold meetings in each of the state's six congressional districts this year to study issues facing the state's poorest citizens and make recommendations to the 2017 legislative session. The first meeting was held in Louisville and focused on the lack of affordable housing.

Mary Lee Underwood of the Commonwealth Council on Developmental Disabilities voiced concern about how the plan, for a waiver of normal Medicaid rules, would impact those with disabilities.

She said some individuals with disabilities and their families under the new plan will be considered able-bodied because they don't receive any Social Security or disability benefits and have been able to get health insurance only through the expansion of Medicaid eligibility to those with incomes up to 138 percent of the federal poverty level. She said one-third of Kentucky adults with disabilities live in poverty.

"We can guarantee that there will be a disparate impact on people with disabilities and their family members because they are so highly represented in the population of people who are living at or near the poverty level," Underwood said.

Underwood also noted that while those who are deemed "medically frail" are "somewhat protected" from the proposed changes, they will have to pay premiums and are subject to the penalties associated with the plan if they don't. She said that the "scary part" is that managed-care organizations, which have a "history of inconsistent application of standards with other Medicaid waivers," will decide who is medically frail.

She and other speakers stressed that the proposal is too complicated. "That complexity will create barriers, especially to those with disabilities who are already struggling to understand multiple systems and to comply with the demands that those systems place on them," Underwood said.

Democratic Rep. Terry Mills of Lebanon said he spent 35 years processing Social Security and disability claims, and "We need to acknowledge that able-bodied is so subjective, it can be dangerous." He also said,  "I sort of formed an opinion during that time that if you want to keep people from asking, make it so complex that barriers are created."

Bill Dolan and Kevin Fleming, lawyers from Kentucky Protection and Advocacy, a government-sponsored group that serves people with disabilities, said they were aggressively seeking clarification from the Cabinet for Health and Family Services to determine which disabled populations would be covered and which would be exempt.

Dolan did offer one of the few positive comments at the meeting, saying that the increased funding for inpatient substance-abuse treatment was a "great thing."

Emily Beauregard, executive director of Kentucky Voices for Health, disputed Health Secretary Vickie Yates Brown Glisson's assertion that the expansion has done nothing to improve the health of Kentuckians.

"It is worth remembering that in 2014 alone, preventive screenings for diabetes and cholesterol doubled, trips to the emergency room decreased, tens of thousands more Kentuckians invested in early detection, treatment and disease management – and that's good for all of us," she said.

Rep. Cluster Howard, D-Jackson, acknowledged surveys that show most Kentuckians want to keep the expansion as it is, but noted that Bevin won by a "substantial margin" in the district he represents and  clearly campaigned on changing Medicaid. "Where did the disconnect occur?" he asked.

Cara Stewart of the Kentucky Equal Justice Center said people vote on more than one issue, and won a laugh when she said, "Also, a lot of people don't pay attention to what people say when they are running."

Beauregard said, "I remember clearly during the election that Governor Bevin said no one is going to lose their coverage. ... When you hear that you feel comfortable, you feel secure with your coverage and you go on to worrying about other things in life."

Rep. Darrell Owens, D-Louisville, passionately pointed out that 70 percent of registered voters did not vote in the governor's race. "The reality is that citizens went to sleep," he said. "So it's an indication to me that we need to be a little more concerned about voting and understanding the issues."

Owens said he thinks the federal government will reject this proposal as it stands now, and Bevin will do what he said he would do: end the expansion, leaving more than 400,000 Kentuckians without health insurance, which is "more folks than voted for him."

Mahak Kalra and Stephen Lin of Kentucky Youth Advocates were glad to see that the plan would not directly affect children and pregnant women, but voiced concerns about parents and children having different benefit packages. "We believe that parents may become confused about the differences in requirements and also the coverage for themselves and their children," Kalra said.

Nicole Huberfeld, a University of Kentucky associate law dean, discussed findings from her paper, "Health Care and the Myth of Self Reliance," which explains why Americans believe what they do about health care access to the poor, and why a single government program for the poor would be more economically and administratively efficient. A report on her views will appear later.

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Health cabinet says it will seek heavy penalties for dumping in Estill and Greenup of radioactive brine from oil and gas drilling

State health officials say they will "seek significant civil penalties" against companies "responsible for the illicit dumping" of radioactive waste in Estill and Greenup counties.

The Cabinet for Health and Family Services, which has authority over radioactive waste, “intends to impose the harshest civil penalties available under the law against all those responsible for the illegal dumping of waste in the Commonwealth,” Secretary Vickie Yates Brown Glisson said in a press release. “We will not tolerate any actions that threaten the health and well-being of our citizens.” She said there are no immediate threats to public health.

One company named in the release is Advanced TENORM Services of West Liberty, which disposed of radioactive brine from oil and gas drilling at the Blue Ridge Landfill in Estill County. (TENORM stands for "technologically enhanced, naturally occurring radioactive material.") The other is Fairmont Brine, which sent similar but less potent waste to the Green Valley Landfill in Greenup County.

Tests at Blue Ridge "showed no evidence that the TENORM dumping led to radiation or radioactive contamination above federal and state safety limits," the release said. It said the cabinet is "working with the Energy and Environment Cabinet and Blue Ridge’s attorney and management to remediate and/or manage the landfill property and ensure that the property remains safe for workers and the general public, regarding both in-state and out-of-state (illegal) TENORM waste," and is "working with outside entities to perform dose assessments on the workers at the landfill. The preliminary results indicate that the workers are not at risk for any negative outcomes."

Democratic Attorney General Andy Beshear decided not to seek criminal penalties against either dumper, citing "insufficient evidence." Beshear said he asked the health cabinet for authorization to seek civil penalties, but the cabinet declined, saying it would handle that.

Under Beshear's father, then-Gov. Steve Beshear, and for a shorter time under Republican Gov. Matt Bevin, the Energy and Environment Cabinet took "seven months to alert Kentucky landfill operators to be on the lookout for illegal shipments of radioactive drilling waste and that they should not accept any it," Jim Bruggers reported in April for The Courier-Journal. "The health cabinet waited another three weeks – until March 4, two days after The Courier-Journal first reported the dumping – to order the company alleged to have quietly brought the waste into Kentucky to stop, and for landfills to stop accepting it."

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