The Obamacare miracle in eastern Kentucky

This week we mentioned the amazing new numbers from Kentucky’s Department of Medicaid Services on what the Affordable Care Act and the expansion of Medicaid has meant for the state. Perhaps the most notable piece of information is the county-by-county map of how the uninsured rate has plummeted, especially in eastern Kentucky. On the House floor on Wednesday, Congressman John Yarmuth made sure to show this map to all of his Republican colleagues who want to repeal the law and most of those Kentuckians’ coverage:

While it is true that these estimates in the map show that the uninsured rate has gone down in every Kentucky county, if you break down the numbers that the Beshear administration used, it becomes apparent that the entire Appalachian region of the state easily benefited from health care reform more than any other.

LEO constructed the map below by using the same figures that the Beshear administration used for their estimates, comparing insurance coverage in Kentucky from 2012 (from the U.S. Census’ Small Area Health Insurance Estimates) to the new figures estimated in 2014 (calculated using Kynect enrollment numbers from the April signup deadline, and estimating that 75 percent of those gaining coverage were previously uninsured, as they indicated when signing up) in order to find out how much the uninsured rate dropped in each county:

kynect percent change map 2

Right there in the heart of anti-Obama coal country, Kentucky saw it’s most dramatic double-digit drops in the percentage of uninsured citizens. There is no other region in Kentucky that benefited more from Obamacare, where you see counties going from 17 percent uninsured to less than 5 percent. This is also the region where President Obama’s approval rating is the likely the lowest, where the mythology of Obama’s “War on Coal” being their singular boogeyman remains virtually unchallenged.

Remember, these figures remain an estimate, as the 75 percent figure surely varies from county to county, along with demographic shifts over the last two years. Additionally, the number of people who actually lost their insurance — and did not just receive a scary letter from their insurance company in the mail — is likely small, but not totally insignificant. But for the most part, these numbers should be extremely close to the reality on the ground.

Now, if there was just a candidate in a very important and high profile race in Kentucky to rally voters around keeping this health care reform in place so that all of this progress doesn’t make a U-turn back to the old pre-ACA days…

If you hear of such a candidate making an effort to highlight this on the campaign trail, please let us know.

***** UPDATE *****

Just to illustrate how much Obamacare has helped anti-Obama voters, David Schankula at B&P points outs this helpful visual evidence:

kynect percent change map 2

Rep. Adams calls out Frankfort’s “game of punishment and retribution” on Seven Counties’ contract termination

Rep. Julie Raque Adams, R-Louisville (LRC Public Information)

Rep. Julie Raque Adams, R-Louisville (LRC Public Information)

As we wrote about in print this week, it is extremely clear that the Government Contract Review Committee in Frankfort terminated a contract with Seven Counties Services not because of their poor performance, but as retaliation against the mental health nonprofit for successfully pulling out of the Kentucky Retirement Systems. Though the Beshear administration is cagey on this, it’s also clear that they did not exercise their option to continue Seven Counties’ contract, instead ending it on Oct. 31.

We had trouble finding any legislators in Louisville who would speak out against this move, but on cn2 Pure Politics last night, Rep. Julie Raque Adams, R-Louisville, told Nick Storm that she “was very disappointed by the action of the committee, and subsequently the action by the administration, to move towards terminating that contract.” On the prospect of more Seven Counties contracts being pulled, Adams added that “The game of punishment and retribution should be over. I think now is the time for us to figure out a solution to this situation so that nobody falls through the cracks.”

That solution Adams refers to may involve Seven Counties offering up some kind of concession for the state, who is picking up the slack on the nonprofits’ retirees, but notes that the $90 million figure cited by KRS and legislators may be way off base.

“I think that the $90 million is in dispute as well,” said Adams. “Seven Counties has made every single contribution required of them to this point, before they had to file for bankruptcy. The problem is that we have these agencies that are so vital to our most vulnerable citizens, that we have to come up with some sort of answer for them. Because you can’t pay 40 cents of every dollar into a pension system and think they’re going to be able to continue serving those most vulnerable in our community.”

Seven Counties spokeswoman Gwen Cooper also told LEO that this $90 million figure for the liability that they supposedly are walking away from is off base.

“There is no liability,” said Cooper. “There’s no mechanism, according to the judge’s ruling, to determine what that liability, if any, would be. So that’s really something that KRS and the state have to work on before we can be held accountable for some fictitious number that nobody can quantify.”

The Government Contract Review Committee’s next meeting is in two weeks. Let’s see if they’ve sent enough of a message to Seven Counties — and other nonprofits considering walking in their footsteps — or if more contracts will enter Frankfort’s butcher shop.

Medicaid expansion leads to booming reimbursements, plunging uninsured rate in Kentucky

Larry Kissner, the commissioner of Kentucky’s Department of Medicaid Services, told a legislative committee in Frankfort last week that Kentucky’s decision to expand Medicaid not only dramatically increased the number of insured Kentuckians taking advantage of preventative screenings, but also the amount of Medicaid reimbursements received by health care providers, particularly hospitals.

One piece of new information revealed was the number of people who signed up for Medicaid through Kynect by the April deadline who are part of the state’s new Medicaid expansion: 290,000, which makes up 88 percent of the 330,000 total, meaning only roughly 40,000 were previously eligible for Medicaid and signed up through the so-called “woodwork effect.” Even though these 40,000 signed up through Kynect, this has not produced a boom in the number of Kentuckians signed up through traditional Medicaid, whom the state has to pay for 30 percent of their costs, as opposed to zero for those under the expansion. As you can see in the numbers provided below, the amount of people signing up for traditional Medicaid actually went down compared to last year:

kentucky medicaid

Kentucky’s Department of Medicaid Services has also provided this map that shows how the uninsured rate has plummeted within each county since 2012, assuming that 75 percent of Kynect enrollees did not previously have insurance (as indicated in their Kynect application):

kynect before and after

While this drop is staggering through the state, it is most pronounced in the four eastern Kentucky counties of Harlan, Letcher, Leslie and Perry, who went from 17-20 percent uninsured to less than 5 percent. These four counties went from some of the highest uninsured rates to the lowest in the entire state. Thanks, Obama.

As the Kentucky Center for Economic Policy noted from Kissner’s last presentation, this new population of insured Kentuckians is putting their new coverage to good use with a large increase in preventative screenings:

According to Commissioner Kissner, in the past year the utilization of an annual dental visit through Medicaid increased by 15.8 percent. Use of adult preventive services increased by 36.7 percent; breast cancer screening increased by 20.6 percent; cervical cancer screening increased by 3 percent; and colorectal cancer screening increased by 16.1 percent.

Kissner also provided numbers for the Medicaid reimbursements of health care providers throughout the state, particularly focusing on the largest beneficiaries: hospitals. Reimbursements went up in fiscal year 2014 (July 2013 through June 2014) for inpatient and outpatient hospitals, physicians and pharmacies from FY 2013, with the total jumping from $3.2 billion last year to $3.4 billion in 2014. The total reimbursements went up by $14 million for rural hospitals and $54 million for urban hospitals.

This increase is mostly due to the reimbursements from those now covered under the Medicaid expansion, which totaled $284 million in just the first six months of 2014. However, this figure is in reality even higher, since this most likely only represents completed claims through March. From these individuals covered under the expansion, hospitals received $135 million in reimbursements, while pharmacies received $77 million, physicians and primary care providers received $42 million, and other providers received $33 million. These new reimbursement totals for the expanded populations were most pronounced in urban hospitals, with the University of Kentucky Hospital receiving $15 million in reimbursements, University of Louisville Hospital receiving $11 million, Norton Hospitals receiving $11 million, and Jewish Hospital & St. Mary’s receiving $9 million.

While federal disproportionate share hospital (DSH) payments — to treat the indigent — will not be reduced until 2016, Kissner’s figures show that Medicaid reimbursements for hospitals through mostly the first three months of 2014 ($104 million) already outpace the total DSH payments for hospitals throughout all of FY 2013 ($97 million). So while these DSH payments will go down in future years, they will be more than made up for by the increase in insured individuals seeking treatment who can actually pay their bills, whether via Medicaid or private insurance.

While rural hospitals in Kentucky still face unique challenges that must be addressed, including how well Medicaid managed care is able to meet the increased demand for providers, the rosy estimates given by Gov. Beshear last year on the effects of embracing the Affordable Care Act appear to be coming to fruition. The question still remains whether Kentucky’s legislature will decide to continue these efforts next year, or whether a possible new Republican majority in the state House will decide to roll back the clock.

16 things I learned from local media last week

Katniss Everdeen is my spirit animal.

Katniss Everdeen is my spirit animal.

1. A heritage pig farmer said this with a straight face: “To save these pigs we have to eat them.” [WFPL]

2. Maybe you should think twice before taking that tiger selfie in Indiana. []

3. Someone put together a list of the unhappiest cities in America. Louisville came in third. Boo hoo. [WAVE]

4. We should be unhappy considering the state of Louisville Metro Animal Services. [The Ville Voice]

5. Police believe less than 3 percent of graffiti is gang related [WDRB]

6. Garfield and other housecats are no longer allowed to roam the streets of Goshen without a leash on. [Courier-Journal]

7. A guy who used to make $325,000 at the C-J is upset and having nightmares about it. [WDRB] 

(DISCLOSURE: I use to work at the C-J. I was paid nowhere near that much. I also have never had nightmares about the newsroom. Mo money, mo problems, I guess.) 

8. This year’s Kentucky State Fair will debut a new menu item: the Hot Brown-On-A-Stick. Be still my stomach. [WHAS]

9. Bowling Green doesn’t have enough going on to sustain a food truck. Yikes. Why aren’t they on the list of unhappiest cities? [WLKY]

10. It costs $100 to replace those carts people steal from grocery stores. [WDRB]

11. Not everyone steals grocery carts. Some people are busy stealing cattle. [C-J]

12. I need to convince my landlord to put in a sliding door oven. [BusinessFirst] 

13. Kentucky has received less than 1 percent of the unaccompanied children crossing into the United States. [WDRB]

14. There are spider monkeys buried in a pet cemetery in southern Indiana. [WLKY]

15. What Would Jesus Drink? Coffee, apparently. [WFPL]

16. Fandom Fest will hold a “Twilight versus Hunger Games” panel. Even without the hometown connection of Jennifer Lawrence, the winner of that battle is obvious. []

Now excuse me while I volunteer as tribute.

Botched execution in Arizona adds to growing evidence of the need for reform in Kentucky

Wednesday in Arizona, James Wood was the third American inmate this year to be slowly tortured to death by a lethal injection that was supposed to be quick and painless. Wood’s execution lasted almost two hours, in which witnesses say he gasped, snorted and convulsed “like a fish on land.” Even Republican Sen. John McCain called the execution “torture,” which is really the only accurate way to describe it. The drug combination used by Arizona is the exact same one that Ohio used in the botched execution of Dennis McGuire earlier this year, and it is the same formula to be used in lethal executions right here in Kentucky.

For a great wrap up of all the barbarism of lethal injection in 2014 America, this clip from Rachel Maddow last night will do the trick:

As LEO has reported in the past few months, a current lawsuit* by seven death row inmates against the state of Kentucky argues that Kentucky’s lethal injection protocols should be ruled unconstitutional, recently seeking to add the evidence of the horrific botched executions in Ohio and Oklahoma. Yesterday, David Barron, their public defender, added a motion to include evidence of the Wood execution in Arizona. From this motion, here is a relevant excerpt that sums up the crazy situation in Kentucky, which has a lethal injection method that has only been used twice in America: The two botched executions in Ohio and Arizona this year.

In opposition to Plaintiffs’ motion to amend, Defendants’ argue that “[t]he use of large dosage of opioids, such as those used in the two drug protocol, has been studied and effectively prevent severe pain.” … Not so, at least when used in the manner Defendants intend to use those drugs to kill Plaintiffs.

We have now had two executions in the country carried out through intravenous injection of midazolam and hydromorphone (one in the dosage Defendants intend to use and one in a much higher dosage). They were two of the lengthiest and most horrific lethal injections ever carried out in this country – so horrific that they resulted in spectacles that have garnered a great deal of national and international media attention and condemnation. They are part and parcel of a 100% disaster rate that, as of now, does not appear likely to change. In virtually any other activity, if something had been tried twice with horrendously disastrous results both times, those in charge would immediately stop doing that which produced those results, proceed to conduct a significant review of the matter, and then either permanently stop the activity or make a significant change to substantially lessen the likelihood that the same result would occur if the matter was ever tried again. It should be no different here. Yet, there is no reason to believe Defendants will do any such thing; after all, they oppose Plaintiffs being allowed to litigate any of these claims and, shockingly, argue that there is nothing wrong with the horrific spectacle that was the execution of Dennis McGuire. Presumably, they could not care less about what happened yesterday in Arizona. Plaintiffs are confident that this Court will not turn a blind eye to what has transpired and will ensure that Plaintiffs receive the opportunity to adequately and fully litigate the constitutional issues arising out of the recent (and only) executions using the two drug protocol.

Let’s wait and see if Kentucky sticks with that “100 percent disaster rate,” or if we’ll just continue to experiment on human being guinea pigs.

*Disclosure: LEO Weekly made a motion to intervene as a party in one aspect of this lawsuit, arguing that we have a First Amendment right to view the insertion of the IV for an inmate being executed in Kentucky. Though this is allowed in other states, Kentucky prohibits this, saying it is not a part of the execution. In Oklahoma this year, the IV for Clayton Lockett took almost an hour to insert, and was not done properly, leading to the slow, torturous death of Lockett. If the IV insertion process is open in Kentucky, it could potentially alert authorities if there are complications with its insertion that warrant intervention, which could have prevented the torture of Lockett.

Rand Paul continues lying about his Civil Rights Act criticism, calls those who bring it up liars

rand fingers 3

Predictably, it appears that Rand Paul did not take our advice on being honest with people about his past statements on the 1964 Civil Rights Act. Instead of giving an honest explanation for why he no longer has a problem with the article of the Civil Rights Act that outlawed racial discrimination in public accommodations by private businesses, today Rand Paul in an interview with WFPL’s Phillip Bailey continued to deny that he (repeatedly) questioned this, and said that those who correctly point this out are the REAL liars.

It’s an issue Paul still bristles at when confronted four years later, repeating no lawmaker on Capitol Hill is trying push minority rights than he is currently.

“Very few people are running around saying, oh something about the Civil Rights Act,” Paul told WFPL. “I’m a proud supporter of the Civil Rights Act and Voting Rights Act. I’m actually working with Democrats on trying to restore aspects of the Voting Rights Act that were struck down. So people who want to say that are simply partisans and they don’t care about the truth too much.

Step No. 1 for outreach to persons of color: Stop lying to them.

It might also help him to stop supporting voter ID laws that disproportionately disenfranchise African-Americans. Or not spread blatantly false rumors about hordes of undocumented children from Central America coming to Ft. Knox, even if speaking out against this scaremongering falsehood wins him some street cred with the anti-immigrant portion of the early Republican primary states in 2016 who don’t like his hollow rhetoric about supporting immigration reform.

Then again, dishonesty oftentimes works in American politics, so who knows?

13 things I learned from local media this week

1. Kentucky has the sixth largest number of high school cigarette smokers. We used to have the most. So, yay? [WDRB]

2. The board of trustees at the University of Louisville recommended president James Ramsey receive a bonus of 25 percent of his $624,000 annual salary. [WFPL]

3. Louisville Metro asked Durham Labs to create a mobile air monitor device that would allow them to track air quality on the go. They made it, and high schoolers bicycled around the city collecting data. [BusinessFirst]

4. The U.S. Marshals Service conducted a status check of the 1,154 registered sex offenders living in Louisville in late June and found that 90 percent of them were compliant. [WHAS]

5. 149 of those registered sex offenders live in my zipcode. [Courier-Journal]

6. Nearly 2,500 students have been charged or arrested during the last three years in connection to Jefferson County Public Schools [WDRB]

7. The Kentucky Center for Investigative Reporting is fighting the good fight with U of L [WFPL]

World's sexiest Lyft driver.

World’s sexiest Lyft driver.

8. The debate on the legalities of driving services like Uber and Lyft has arrived in Kentucky. [BusinessFirst]

9. Most of the world’s Post-it Notes are made in Cynthiana, Kentucky. [WDRB]

10. If you had $100 million, you could buy 1.333 million Louisville Slugger bats. [WFPL] 

11. It’s not entirely my fault I can’t stick to my grocery budget. [WDRB]

12. People still use three-way calling, apparently. [WAVE]

13. HIGHLANDS CHIPOTLE IS ALMOST OPEN. All caps because I’m #TeamChipotle and this excites me. [BusinessFirst]

Great. Now I’m hungry and worried about sex offenders. Pardon me while I give myself a 25 percent bonus by stealing somebody’s sandwich out of the LEO break room.

6th Circuit Court of Appeals grants motion to consolidate Kentucky’s same-sex marriage cases, expediting decision


The 6th Circuit Court of Appeals ruled yesterday that the joint motion by the plaintiffs and defendant in the Love v. Beshear case has been granted, which will significantly speed up the process for a final ruling in the case that could finally legalize same-sex marriage in Kentucky.

Here is the statement by Gov. Steve Beshear on the order:

“We have joined with the plaintiffs in the Love case and filed a joint motion to consolidate the Love appeal with the Bourke appeal to expedite the briefing so it can be argued Aug. 6 before the Sixth Circuit along with the cases from Michigan, Ohio and Tennessee. This is part of our ongoing effort to ensure the matter is fully before the Sixth Circuit and to bring finality and certainty to this matter for the people of Kentucky in the quickest possible manner.”

These consolidated cases will be argued before the court on Aug. 6 in Cincinnati, along with the same-sex marriage cases of Tennessee, Michigan and Ohio. According to Love and Bourke attorney Joe Dunman, this consolidation significantly speeds up the Love case, which could have drug on for a considerable amount of time. If the court upholds the decision of Judge Shepherd, Dunman says there is a good chance that such a ruling would be in by early October, which would mean it could immediately go to that months’ session of the Supreme Court.

Based on the recent experience of the Utah same-sex marriage case, the court may stay the ruling until the Supreme Court makes a decision, so it might not be time to start reserving spaces for your October wedding reception. Next year, however… who knows?

Also, let’s all hope that we can look forward to Ruth Bader Ginsburg giving her thoughts on that “birth rate” argument by Beshear’s lawyers. But at least Beshear has sped up the process, which is one of the things he said he was trying to do all along.

Housing Authority delays decision on proposed rent-reform study (aka the “experiment on black women”)

Section 8 residents and housing advocates scored a victory last week as Louisville Metro Housing Authority decided to delay their plans to vote on participating in a controversial rent-reform study being described by some as “an experiment on black women and children.”

LEO wrote about the proposed Housing and Urban Development-sponsored study last month. Here’s a recap:

The study — entitled the Housing Choice Voucher Rent Reform Study — would modify policies and rent calculations for a group of 1,000 randomly selected participants and compare the results to a control group operating under current policies and procedures. Those chosen for the study cannot opt out. Among the major modifications for them: determining the percentage of Section 8 rent you pay based on your gross income rather than an adjusted gross income that factors in things like childcare and medical expenses, and instilling a minimum rent payment.

The mandatory public comment period ended on Sunday, meaning the board could have voted on participating. However, according to the housing authority’s executive director, Tim Barry, a decision was made last week to indefinitely delay a vote in order to address the “unanswered questions and misinformation out there.” Barry says the board wholeheartedly agreed that no decision should be made until further discussions, especially face-to-face ones, can be had.

“I felt obligated to stop the process. There’s no need to rush through anything,” says Barry, adding that the housing authority has been meeting with local advocates to address what he has already acknowledged are “legitimate concerns.” Similarly, they have met with professors from the University of Louisville, who will be sending them suggestions regarding the study.

Since the study was quietly announced earlier this summer, local housing advocates and Section 8 recipients have expressed outrage over the city’s seeming willingness to participate in the study, which they see as an unnecessary experiment on low-income women of color, who make up a disproportionate percentage of the individuals within Section 8.

The ACLU of Kentucky  submitted a formal comment to the housing authority requesting that they refuse to participate in the study. In a press release sharing those comments, executive director Michael Aldridge said,

The cornerstone of our democracy is that individuals will be treated equally. But if the Housing Authority chooses to participate in the rent reform study, it will raise certain individuals’ housing costs purely at random. … The disparate impact this study would have upon people of color, particularly African American women, is also troubling.   Whatever legitimate reasons the Housing Authority may have for examining new rent calculation formulas, we think it inadvisable and a denial of fundamental fairness to randomly (and thus arbitrarily) select people for participation in a social experiment of this type.

In a separate press release, Kathleen Parks, co-chair of the Kentucky Alliance Against Racist and Political Repression, said,

From slavery to Jim Crow, African Americans have been America’s favorite guinea pig because we were labeled as brainless, useless, subhuman and inferior to whites, and they wonder why we don’t trust this structurally imbalanced housing system that has the audacity to impose a culturally biased study on black women against their will…

Leaders from the Metropolitan Housing Coalition, Kentuckians for the Commonwealth, Louisville Showing Up for Racial Justice, National Action Network’s Metro Louisville Chapter, Women in Transition and the Fairness Campaign have expressed similar concerns. Miriam Williams, a program coordinator at the University of Louisville Anne Braden Institute for Social Justice Research, wrote an op-ed in the Courier-Journal last week.

Protestors from several organizations attended the housing authority’s board meeting on Tuesday. (WHAS and the C-J have photos and videos of that protest here and here, respectively.)

Human trafficking case won’t proceed

Last month, we wrote about the challenges associated with identifying and prosecuting labor trafficking. Today, there’s a new development in the case that prompted that story.

WLKY reports that Jefferson County District Court Judge Sean Delahanty has said the allegations against Golden Palace Buffet owner Ming Wen Chen don’t constitute human trafficking. Chen and his wife were arrested in May after a yearlong investigation by Louisville Metro Police Department. Detectives say the couple forced their employees to work 12-hour shifts six days a week for almost no pay at the Outer Loop restaurant and restricted their freedom outside of work. The workers did not have passports, and some were unaware of what city they were in.

According to the news report, Delahanty said that this “may be in violation of wage and hour laws, may be in violation of human decency. I do not believe all of that constituted a crime.”

As Sgt. Andre Bottoms and others told LEO last month, labor trafficking is difficult to prove and prosecute, perhaps even more so than the related crime of sex trafficking. The line between what constitutes labor trafficking versus traditional labor violations comes down to coercion.

The WLKY report notes that the commonwealth attorney’s office can still indict Chen in circuit court and that a spokeswoman said they are aware of the case and might review it further.