States all over the map in setting up health insurance exchanges; Kentucky officials say they await more federal guidance

A breakdown of where states stand in implementing pieces of the federal health-care reform law shows Kentucky lagging behind. But Kentucky officials say they're awaiting more direction from the federal government before they decide their next move.

A map compiled by the Center for Budget and Policy Priorities shows Kentucky is one of 11 states that did not even introduce legislation to form a health insurance exchange, considered one of the cornerstones of the new health care law. The center says 33 states have considered bills to establish an exchange, and 10 passed. Another nine have approved bills declaring the state's intent to establish them.

The state exchanges, which are to be launched in 2014, will act as insurance marketplaces. In the exchange, individuals and employees of small businesses can choose from several plans from companies such as Anthem or Bluecross/Blueshield, whose benefits coverage packages have been pre-approved by the state and federal governments.

As part of the new law, individuals with income as much as 400 percent above the poverty level may qualify to buy insurance from the exchange. Individuals that do qualify will be given federal subsidies to help pay their premiums, subsidies people can only get if they buy their insurance through the exchange. "They'll be incentivized to buy their insurance through it," said Carrie Banahan, executive director of the Office of Health Policy in the Cabinet for Health and Family Services.

So far, though, Kentucky has not made any moves toward setting up its exchange. Banahan said that is largely because the federal government has not decided what benefits the plans in the exchange must include. "They'll basically set up a minimum of what these plans need to include," she said. "We're still awaiting federal guidance."

Asked if the administration of Gov. Steve Beshear is delaying action so the health-care law won't become an issue in the Nov. 8 election, in which Beshear is seeking a second term, chief cabinet spokeswoman Jill Midkiff replied in an email, "The federal government has not issued final guidance through regulations on the exchange. States cannot make decisions to establish an exchanghe without knowing the requirements in order to determine programmatic and financial implications."

If states don't set up an exchange on their own, the federal government will do it for them, though Banahan said Kentucky officials are reluctant to let that happen. "The federal government is encouraging states to operate their own exchanges," she said. "They're looking at states to take the lead so they can model and craft their own exchange to meet the needs of their state. If the federal government came in, they don't know Kentuckians like we know Kentuckians."

As indicated by the map, several states have chosen to create an exchange by passing legislation. In some others, governors have done it through executive orders. Banahan said there is still time for Kentucky to weigh its options. "We haven't missed the boat," she said. "We're still just looking ... No final decisions have been made."

Other states' decisions do not necessarily follow party lines. Nevada and California passed exchange bills under the leadership of Republican governors. Delaware and Rhode Island, which have Democratic governors, have not budged on exchange legislation.

Only Florida and Louisiana have "expressly stated they won't build the marketplace," Sarah Kliff wrote for The Washington Post. Both have Republican governors, "But there are a lot of other states in the gray area above that could fall either way. If a few larger ones like Texas or New York aren't able to move forward in the next year or so, that's going to have the federal government playing a really big role in setting up what was meant to be a state-based law." (Read more)

Ultimately, whether Kentucky sets up its own exchange or the federal government does, Banahan said an exchange is needed. "We think it's a good thing that more people will have health insurance accessible to them," she said.

Kentucky's adult smoking rate falls below 25% for the first time

For the first time since state smoking rates were measured, fewer than one in four Kentucky adults are smokers, according to a report by the Centers for Disease Control and Prevention. The rate in 2010 was 24.8 percent, down from 28.7 percent in 2009. The rates are based on a national survey of 17,000 adults.

The national average of 19.3 percent, down 1.6 percent from 2005, is "slower than in the previous five-year period," the CDC reports in a release. This decline may be due in part to "increases in federal and state taxes on cigarettes and new clean air laws," Dr. Tim McAfee, director of the CDC's office on smoking and health told Lindsey Tanner of The Associated Press. (Read more)

Death of personal-care home resident has lawmakers from his hometown talking about stricter staffing rules

The death of a missing personal-care home resident has a bipartisan pair of Kentucky lawmakers from his home town of talking about setting staffng standards for Kentucky's personal-care homes or even nursing homes, which have successfully lobbied against such regulation.

Republican Sen. Jimmy Higdon and Democratic Rep. Terry Mills of Lebanon participated in the search that led to the discovery of Falmouth Nursing Home resident Larry Lee's body, Valarie Honeycutt Spears of the Lexington Herald-Leader reports. Following the search, they agreed tougher legislation is needed for personal-care homes.

State regulations on staffing for such homes are vague, stating staff-to-resident ratios should be based on the number of patients and the supervision required to meet their needs, Spears reports.

Higdon plans to address staff-to-resident ratios, resident activities, aging facilities and other problems through legislation. He said he may also support legislation that would create procedures for communities to follow when vulnerable community members go missing.

Mills wants the General Assembly to investigate staff-to-resident ratios for all long-term care facilities, including nursing homes. He said he and Higdon have discussed a "call for a task force to study conditions at personal-care homes." (Read more)

3 universites and federal agency join to improve oral health in Appalachian Kentucky

With money from the Appalachian Regional Commission and some of their own, three very different Kentucky universities will collaborate "to enhance sustainable, collaborative dental health education and care" in the state's eastern coalfield, where both are sorely lacking, they announced in a press release.

Morehead State University, the private University of Pikeville, and the University of Kentucky's College of Dentistry will design the Appalachian Rural Dental Educational Partnership Plan "to train more dentists to practice in rural areas and give them the tools necessary to set up thriving dental practices in Eastern Kentucky," the release said. The funding is $400,000 from ARC, $127,293 from UK, $82,035 from UPike and $47,873 from Morehead State.

“The majority of Eastern Kentuckians have struggled to sustain quality dental health, and one of the barriers to maintaining good dental health is poor access of quality dental care,” state Department for Local Government Commissioner Tony Wilder said. His agency handles ARC matters in Kentucky.

Said new UK President Eli Capilouto, a dentist by trade, “We know that if we can break a cycle of poor health, we can begin to break cycles of poverty. Cycles of despair can become legacies of hope. We also, increasingly, know that partnerships and greater collaboration are the best – and, perhaps, only – way to address major challenges.” He called the project a unique partnership among a federal agency, a governor and “the state’s flagship institution, Kentucky’s public institution dedicated to serving the people of Eastern Kentucky, and a critically important college with deep roots in Eastern Kentucky.” (Read more)