What will high court do on health law? 4 most possible scenarios

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker — or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people — the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 — that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)

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Bill amendment could make dental, vision care more expensive

A last-minute amendment to a bill intended to limit when insurance companies could terminate policies may end up costing Kentuckians more out-of-pocket dental and vision expenses, Courier-Journal political writer Joseph Gerth writes in his weekly column.

The implications of House Bill 497 changed when Sen. Tom Buford, R-Nicholasville, "filed a one-paragraph amendment that was brought to him at the last minute by a lobbyist for the Kentucky Dental Association," Gerth writes. "That amendment said that if you have vision or vision insurance, your insurance provider can't require your health care provider to give you discounted rates on services that aren't paid for by the insurance plan."

That could mean that low-cost plans that only cover a few procedures but offer "added benefit by making sure you're not paying inflated prices for other services" may no longer be available, Gerth reports. Opponents say insurance companies will stop offering such plans because people won't buy them without the discounts. And people who can't afford more expensive plans will sacrifice dental and vision insurance.

On Tuesday, the Senate adopted the amendment and passed the bill. The bill cleared the House the next day. Gov. Steve Beshear has not indicated if he will sign or veto it.

Advocates say the bill will save in dental and vision care costs. Opponents say people will have difficulty having access to case. As for who's right, Gerth writes: "Bill advocates have presented no evidence to suggest that, and there have been no full-fledged hearings for the dentists behind the bill to make their case or to answer the questions that need to be asked." (Read more)

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Will birth-control mandate cost more or less? Yet to be seen

Will requiring insurance companies to provide contraception be cost-neutral, as the Obama administration claims? It is unclear, and so is whether insurance companies will make Catholic institutions pay more. These were the findings of FactCheck.org, a nonpartisan, nonprofit, consumer-advocate project funded by the Annenberg Public Policy Center of the University of Pennsylvania.

In support of its claim, the administration cites data from Hawaii's birth-control mandate, which shows health insurance premiums "did not appear" to increase. The study also found the number of pregnancies increased after contraception coverage was required.

But when Pennsylvania considered imposing a similar mandate, a state agency found "the amount of possible savings relative to the cost of the legislation is unclear." Findings were also unclear in Connecticut when officials there looked at whether or not insurance plans saved enough because there were fewer pregnancies to offset the cost of providing coverage. A Texas study found insurance companies would not save enough because women would buy contraception on their own.

A recent survey of 15 insurance companies found six thought costs would increase and another three felt the move would be neutral in cost. None felt they would save money because of the mandate.

"Until better data are available, we're unable to conclude whether the Obama birth-control mandate is likely to result in a net cost increase or not," FactCheck reports.

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Kentucky receives $57.9 million to set up insurance exchange

Kentucky received $57.9 million Wednesday to help set up a health insurance exchange or marketplace — though lawmakers have made no move to make that happen. Kentucky is one of 10 states to receive this latest round of federal insurance exchange establishment funds, which totals $230 million. Of these 10 states, Kentucky received the highest sum by several million.

Of the 10 latest states to receive grants, seven of them have adopted a plan or made substantial headway, reports Richardo Alonso-Zaldivar for The Associated Press. In the exchange, considered one of the cornerstones of the new health care law, individuals and employees of small businesses can choose from several plans whose benefits coverage packages have been pre-approved by the state and federal governments.

So far, 30 states and the District and Columbia have received grants. Of those, only 13 and the District of Columbia have adopted a plan for how to proceed. States have until Jan. 1, 2013.

"Kentucky has not determined whether it will establish a health benefit exchange in light of challenges to the Affordable Care Act and the lack of federal guidance and a tangible federal exchange model to consider," said Kerry Richardson, communications director for the Office of Gov. Steve Beshear, said at the end of January. "However, impending ACA deadlines require considerable planning, evaluation, design and development of systems to address exchange issues whether the state or the federal government operates the exchange, and we are engaged in those efforts."

In September 2010, the Kentucky Cabinet for Health and Family Services' Office of Health Policy received a $1 million exchange planning grant. In August, it received another $7.7 million to fund information technology systems. No bill has been introduced that would establish a state-based health insurance exchange so far. (Read more)

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Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

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Kentucky and most other states continue to delay action on health-insurance exchanges, despite Jan. 1, 2013 deadline

Though states must be able to prove whether or not they're ready to run a state insurance exchange by Jan. 1, 2013, many, including Kentucky, have not made any moves toward setting one up.

Kentucky officials have said they are waiting for more guidance to come from the federal level before anything can be decided, but there were indications that the administration of Gov. Steve Beshear might have been delaying action until last month's gubernatorial election. If Kentucky were to set up its own exchange, a move would likely have to be made in the 2012 General Assembly.

Jason Millman of Politico Pro writes an easy-to-understand summary of the complex issue and what it will mean for the American public: "Set to open in January 2014, exchanges will offer a marketplace where individuals and small businesses in each state can shop for health coverage. The exchanges, which offer subsidized coverage to lower- and middle-income individuals, will absorb more than half of the law's projected expansion of health coverage to 32 million people."

Some Republican-dominated states are waiting to see if the U.S. Supreme Court will rule the federal health-care reform law or its individual mandate unconstitutional, but a ruling is not expected until June at the earliest. "If that's when they start to work on an exchange, they will certainly be challenged to have a state-based exchange in 2014," said Steve Larsen, who oversees exchange development for the U.S. Department of Health and Human Services.

Wisconsin state Sen. Frank Larsee, chairman of the insurance committee, plans to wait even longer — opting to wait until after the 2012 presidential election. "Exchanges really aren't required until 2014, so we have plenty of time after November 2012," he said, not addressing the Jan. 2013 deadline.

So far, just 13 states have passed legislation to form an exchange. (Read more)

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Smokers should pay more for health insurance, but obese should not, national poll finds

Nearly 60 percent of people in October's Thomson Reuters-NPR Health Poll said smokers should pay more for their health insurance than those who don't smoke, but 69 percent said "no" when asked if people who are overweight or obese should pay more.

Support for punishing smokers was greatest among groups less likely to smoke. Almost three-fourths of people in households with an annual income of $100,000 or more felt smokers should pay more than nonsmokers, Sarah Kliff of The Washington Post reports. There was nearly as much support — 70 percent — among people asked with at least a college degree.

But when it came to the weight-related question, the majority of people, regardless of education or household income, did not support having people who are overweight or obese pay more. Just 31 percent supported the idea.

Overwhelmingly, nearly 85 percent of respondents felt people who eat right and do not smoke should receive a discount on their health insurance premiums.

Each month, the poll surveys 3,000 Americans to gauge opinions on a variety of health-care topics. The poll, which is independently funded, has a margin of error of 1.8 percent. (Read more)

The poll results were released at a time when many mid- and large-scale companies are asking their smoking, obese employees to pay higher premiums than their more healthy colleagues. In 2012, almost 40 percent of these companies, including Walmart, will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009. (Read more)

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Hike in health insurance premiums due to rising health costs, not reform law, FactCheck.org concludes

Health insurance premiums for employer-sponsored family plans shot up by 9 percent from 2010 to 2011, but the bulk of the hike is due to the increase in health care costs, not the federal health-care reform law, non-partisan FactCheck.org has found.

The law is responsible for about 1 to 3 percent of the increase, however, in large part because the law requires an increase in benefits, including: covering preventive care without co-pays or deductibles; allowing adult children to stay on parents' policies until age 26; increasing annual coverage limits; and covering children regardless of preexisting conditions.

"On the other hand, the fact that the law caused any increase at all casts more doubt on Obama's promise that the law 'could save families $2,500 in the comings years.' We've been calling that claim into question for several years now," Factcheck.org stares. "The plan fact is that — so far — the law has caused an increase in premiums, though not so large an increase as some Republicans claim." (Read more)

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Haven't quit smoking, lost weight? Pay more for health insurance, more companies say

In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)

The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.

One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."

Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."

Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."

Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Group on Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."

Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)

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Conway supports, P'Pool opposes meds-for-meth law; Conway defends decsion not to join lawsuits about federal health reform

In a debate where most of the sparks flew over often-specious questions about conflicts of interest, one of the biggest substantive disagreements between the candidates for attorney general Monday night was about whether to require a prescription for the cold medicine used to make methamphetamine. They also debated President Obama's health-care reform law.

Democratic Attorney General Jack Conway. left, said he supports such a law, which failed in this year's General Assembly, while Hopkins County Attorney Todd P'Pool, right, said he opposes it. The candidates were interviewed by Bill Goodman on KET's "Kentucky Tonight" as part of a series of debates between statewide candidates in the Nov. 8 election.

Republican P'Pool, the first to respond to Goodman's question, said he opposes making pseudoephedrine a scheduled drug because "I think it creates a burden for law-abiding citizens. . . . Let's don’t put a burden on soccer moms." He said he would support "a lifetime ban," which he did not explain, "for anyone convicted of a meth crime."

Conway said his position in favor of scheduling "is not the most politically popular position," but said he responded to a plea from "my friend Hal Rogers," the Republican congressman from Somerset who is a leading advocate. "I know it's not popular with some soccer moms," Conway said, and "I know it's inconvenient" to require a prescription, "but when you see a kid in a burn unit that’s gone through a meth lab it tears your heart." He said children at present at 80 percent of meth labs.

Conway said he is open to changing his position if opponents can show him how to prevent "smurfing," the use of surrogates to avoid the recordkeeping of pseudoephedrine purchases. He said many drug stories do not use the online recordkeeping system. He added that Oregon and Mississippi had "dramatic declines" in the number of meth labs after they scheduled pseudoephedrine.

P'Pool began the debate by sharply criticizing Conway's decision not to join lawsuits by Republican attorneys general challenging the constitutionality of the federal health-reform law: "He's absent form the fight against Obamacare … because he supports Barack Obama and his re-election." Conway replied, "I'm not gonna take some of the valuable resourecs of the office of the attorney general and put 'em on a lawsuit on health care when it’s an issue that’s gonna get decided anyway." He said some attorneys general are supporting the law in court, and "I didn’t join them either because I wanted to focus on Kentucky first."

As Goodman pressed the point, P'Pool said, "It’s really not about health care; it's about the proper role of the federal government." He said Kentucky could join the case with the stroke of a pen, but "My opponent has not been bashful in his support of Barack Obama and that’s why he’s on the sidelines."

Conway replied that the lawsuit "might undo some of the underpinning" of Social Security and Medicare laws. "This is not a perfect bill; some things need to be fixed in health-care reform," he said, but he implicitly defended the bill's requirement to buy health insurance: "It costs Americans on average $46 billion a year to cover the uninsured," he said. "They’re going to the emergency room to get their care … They’re already in the market. This is about being more efficient."

Click here for a story on the debate by Deborah Yetter of The Courier-Journal. Video of the debate is posted online here.

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Health exchange could cost up to $34 million in Ohio; Kentucky still biding its time -- until after the election?

As 27 states, including Kentucky, bide their time in setting up a health care exchange — a key component of the federal health-reform law — Ohio officials have said setting one up in their state will cost $19 million to $34 million.

The undertaking could cost $8 million a year just for staff salaries, with 170 employees needed to run the exchange, reports Cliff Peale of the Cincinnati Enquirer. Marketing could cost $5 million a year, said a health-care consultant at Milliman Inc., an actuarial and consulting firm.

"Ideally, we want to see Obamacare repealed," said Susan Verble, deputy chief of staff for Ohio Lt. Gov. Mary Taylor, who also directs the Ohio Department of Insurance. "Whether it's a state or federal-run exchange, it's going to be costly for taxpayers."

Starting in January 2014, "the law will require all Americans to buy health insurance or pay a penalty and require companies with more than 50 workers to offer benefits or pay a penalty," Peale reports. Ohio and Kentucky have each received $1 million from the federal government to research how to start an exchange.

Kentucky has not decided whether it will operate an exchange. Officials with the Cabinet for Health and Family Services said last month Kentucky is still awaiting guidance from the federal government, but didn't respond directly when asked if the impending election for governor was also a factor. (Read more)

Tonight, acting Gov. Earl Ray Tomblin of West Virginia narrowly won a special election for the remainder of an unexpired term, after losing a big lead. The final television commercial from the Republican Governors Association was an attack that Kentucky Gov. Steve Beshear may be trying to avoid: A link between a Democratic governor and the unpopular Democratic president's health-care law, passed with only Democratic votes. --Al Cross, Institute for Rural Journalism and Community Issues

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New survey shows dramatic increase in employer-sponsored health insurance rates

The average cost of employer-sponsored health insurance has increased 9 percent for family coverage and 8 percent for individual coverage since last year, a new study by the Kaiser Family Foundation and the Health Research & Education Trust shows. "Both increases are the largest since 2005," Tony Pugh of McClatchy Newspapers writes, surpassing the national 2 percent increase in wages and 3.2 percent increase in inflation.

Since 2001, family coverage premiums have escalated 113 percent while workers' wages have only risen 34 percent and inflation – 27 percent, Pugh reports. Researchers are unclear if the increase in premiums is temporary or whether higher increases will continue. "We really don't know, and we won't know until next year," Drew Altman, president and CEO of the Kaiser Family Foundation told Pugh.

Employers pay on average about 72 percent toward family coverage and 82 percent for single coverage, Pugh reports, leaving workers paying 28 percent for family and 18 percent for single coverage. Of those surveyed, about 31 percent of covered workers were in high-deductible plans, a 10 percent increase from 2006.

Increasing costs in medical care is "the main culprit behind the rate increases," Karen Ignagni, president of America's Health Insurance Plans told Pugh. "Insurers' expectation of stronger economic recovery" and insurers' fears of increased costs from the 2010 Affordable Care Act may be driving higher premiums, Pugh reports.

Despite insurers' fears, an analysis by Kaiser and the federal government suggest that the 2010 Affordable Care Act accounts for only 1 to 2 percentage points of the increase. Only two measures, coverage of adult children to age 26 and no patient cost-sharing coverage on certain preventive medical services, were implemented thus far with the remaining provisions taking effect in 2014, Pugh reports. This month, insurers will be required to publicly disclose information about rate increases of 10 percent or more for review by state or federal officials to determine if the increase is warranted. (Read more)

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Lexington council turns to wellness center to cut insurance costs

Following a national trend to improve employee health so companies can cut health-insurance costs, the Lexington-Fayette Urban County Council agreed Tuesday to set up a wellness center for city employees.

The center will "be voluntary and free for employees, retirees and dependents covered by the city's health insurance plan," reports Beverly Fortune of the Lexington Herald-Leader. Acute and primary care, chronic-disease management and preventive screenings will be among the services provided at the center, the location of which has not yet been chosen. It is estimated to cost $1.3 million.

Chattanooga opened a similar center in 2006. Its health insurance costs were increasing about 20 percent annually, with health benefits costing the city $16 million that year. Today, the city is saving about $5 million a year, said Madeline Green, director of risk management and incentives for the city. (Read more)

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A million more young adults have health coverage; law cited

One million more young adults ages 19 to 25 had health insurance in the first quarter of 2011 than in the same period a year ago, data from the National Health Interview Survey show.

The increase is largely due to the federal health-reform law, which allows children to remain on their parents' health insurance plans until age 26, a press release from the U.S. Department of Health and Human Services said. No other age group had a significant increase in coverage. (Read more)

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Feds give Ky. $3 million to hold health insurers accountable

Kentucky will receive more than $3.2 million in federal grants to help state officials track health-insurance premium increases and make insurers more accountable.

The funds are part of guidelines set forth in the Patient Protection and Affordable Care Act, the federal health reform law. It requires makes rate increases of 10 percent or more in the individual and small-group market subject to approval by experts who will determine if the increases are reasonable. The law also requires insurers to to justify to the public rates that are considered unreasonable.

The Kentucky Department of Insurance will use the federal funds to expand the scope of its rate reviews; improve transparency by establishing a tool on its website that will give consumers access to rate filings without an open records request; hire new staff, and improve its technology. (Read more)

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Last year, 17.4 percent of Kentuckians lived in poverty and 17.5 percent did not have health insurance

More than one in six Kentuckians lived in poverty last year and almost exactly the same number didn't have health insurance, preliminary U.S. Census numbers show.

The state's poverty rate was 17.4 percent and the uninsured rate was 17.5 percent. Nationwide, 15.1 percent of Americans lived in poverty and 16.3 percent were without health insurance in 2010, reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

To be considered to be living below the poverty line, a family of four must earn less than $22,314 each year.

About 640,000 Kentuckians do not have health insurance. Those numbers have risen as employers have stopped offering coverage to employees, said Jason Bailey, director of the Kentucky Center for Economic Policy. In 2000, 65 percent of Kentuckians had employer-based insurance, but in 2010 only 57 percent did.

Medicaid, which provides coverage for the country's poor and disabled, covered almost 1 in 5 Kentuckians in 2010, up from 1 in 10 in 2000, Bailey said. "The percent of children covered by Medicaid in Kentucky rose 6 percentage points since 2007-08, to 40 percent, keeping the number of uninsured children low," Spears reports. (Read more)

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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.

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Medicaid matters, and makes people healthier, study finds, contradicting argument that it's worse than no coverage

Though the overhaul of Kentucky's Medicaid program has its critics and could potentially be confusing to patients, the program itself is very important, acording to a new study. It found that people on Medicaid, compared to those with no insurance, "had better access to and used more health care; they were less likely to experience unpaid medical bills; they were more likely to report being in good health; and they were less likely to report feeling depressed," National Public Radio's Julie Rovner reports.

"What we found in a nutshell is that having Medicaid makes a big difference in people's lives," said Amy Finkelstein, a Massachusetts Institute of Technology economist and one of the study's main researchers. "We report almost a one-third increase in the probability that you report yourself as being happy."

The study also concluded that Medicaid recipients got outpatient care 35 percent more often than those who don't have insurance. They also responded their had own doctor 55 percent more often and a regular office or clinic they went to 70 percent more often than people without Medicaid coverage.

The findings run counter to arguments by critics of Medicaid, including Scott Gottlieb, who wrote an opinion piece in the Wall Street Journal headlined, "Medicaid Is Worse Than No Coverage At All."

While conservatives have long been critical of the program and liberals supportive of it, the study, being published as a working paper by the National Bureau of Economic Research, seems above political gaming; one of its researchers was an economic advisor to President George W. Bush and another an advisor to the Obama administration. (Read more)

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State website helps Kentuckians get health insurance, info

A new government website is aimed at helping Kentuckians wade through the often overwhelming world of health insurance by providing information specific to the new health care law.

The Kentucky Health Insurance Advocate contains information for people who are uninsured, those who are soon to be uninsured, and those interested in private coverage options. It outlines specific information for seniors, children and young adults. It also contains a listing of companies selling individual, private insurance in Kentucky.

The website was compiled by the Kentucky Department of Insurance and has been in operation since the spring. "This is part of a consumer assistance grant we got as part of federal health reform," said Ronda Sloan, public information officer with the department. "We were trying to put all of the health reform information people would need in one location. ... We're trying to make it really user-friendly."

Part of of the effort is to get more Kentuckians insured. "And it's really for education too," Sloan said. "We're not trying to tell anybody, 'This is what you do,' we're trying to say, 'These are your options.' We're trying to walk people through the process."

In addition to perusing the website, people can call toll-free at 877-587-7222 to get more, personalized information. Since the department started advertising the site a few weeks ago, it has received more calls. "A lot of people are saying, 'I'm uninsured,' 'I have a pre-existing condition, what can I do?', 'I lost my job, I'm coming off COBRA,' things like that," Sloan said. "Insurance is not a simple thing and it's not something you think about until you need," she said. "We're trying to make it a little less complicated and try to ease people's minds a little."

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More Americans are choosing health insurance with high deductibles, lower premiums; study says that strategy pays off

In order to pay lower premiums on their health insurance, Americans are opting for plans that have cheaper  monthly premiums but higher deductibles, USA Today's Kelly Kennedy reports.

In 2007, about 4.5 million people opted for high-deductible plans. By 2010 that number had more than doubled to 10 million, an America's Health Insurance Plans survey found. Having high deductibles saves $85 to $100 a month on premiums, but runs the risk of paying more when services are used. It's important for purchasers to understand that lower premiums can mean higher doctors' bills, said Karen Ignagni, president of the industry group.

However, a RAND Corp. study found that people on high-deductible plans pay considerably less than people on traditional plans. "RAND researchers also found that people on high-deductible plans — no matter their income level — received less preventive care: fewer annual exams, fewer cervical cancer screenings and fewer colonoscopies," Kennedy reports. The federal health reform law is preventing some of that from happening, however. Now, most high-deductible plans have to include basic preventive care like colonoscopies.

High-deductible plans are expected to become more common, especially since 47 percent of people who are insured through their employers have high-deductible plans. "Employers like the plans because it's cheaper to insure an employee — about $133 less per family at companies that offer only the high-deductible plans, according to a study in the American Journal of Managed Care," Kennedy reports. (Read more)

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