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As Bevin Eyes Health Care Rollback, Beshear Touts Progress

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With uncertainty about the future of his signature health initiative, Gov. Steve Beshear is touting the outcomes of Kentucky's efforts to improve the well-being of residents.

Beshear's office has released the final kyhealthnow report, giving a picture of where Kentucky stands on meeting health goals set in 2014.

The report was released just weeks before Governor-elect Matt Bevin takes office. Bevin has actively opposed a key part of Beshear's health efforts: the state's health insurance exchange and Medicaid expansion.

Bevin has said he intends to dismantle the exchange, called Kynect, and roll back the Medicaid expansion, citing its estimated $409 million annual cost, which the state would have to pay starting in 2020. On Friday, Beshear defended the programs at a news conference.

As for the bigger picture of health in Kentucky, the Beshear administration says it has made progress. Here are several takeaways from the kyhealthnow report:

Drop in Number of Uninsured

Before the Affordable Care Act and Medicaid expansion, Kentucky's uninsured rate was 20.4 percent. Now, the state has an uninsured rate that hovers around 9 percent, according to Gallup-Healthways.

According to the U.S. Census Bureau, Kentucky's drop in its rate of uninsured leads the nation.

Lt. Gov. Crit Luallen, chair of the kyhealthnow oversight team, said Kentuckians' health had not improved in 25 years. But the report shows the state is finally making strides.

"And regardless of your politics, there's no denying that our collective health is improving," she said.

More than 400,000 Kentuckians enrolled in health coverage during the first year of open enrollment under Kynect; more than 330,000 of them enrolled in Medicaid.

During the second enrollment period, more than 150,000 people signed up for a qualified health plan and more than 55,000 enrolled in Medicaid.

The report also shows that in 2014, Medicaid recipients received 159,500 preventive dental services; about 51,300 breast cancer screenings; and more than 35,600 colorectal cancer screenings. Increases in screenings were also seen for cholesterol, cervical cancer and diabetes.

"We're well on our way to achieving the goal that even our most vulnerable citizens have the benefit of affordable health care," Luallen said.

Smoking

Kentucky has the highest smoking rate in the nation at 30.2 percent, according to the most recent Gallup-Healthways report. The state also has the highest lung cancer death rate in the U.S., according to the Centers for Disease Control and Prevention.

Efforts to institute a statewide smoking ban have failed. And Bevin opposes such a ban, saying the decision should be left to local governments. Louisville banned smoking in most public places a decade ago.

A total of 25 comprehensive smoke-free ordinances have been enacted by local governments, covering a total of 32.7 percent of Kentucky’s population, according to the report.

"Smoking is the No.1 preventable cause of death in the country, and this is an area where Kentucky has ranked 50th. We have now moved to 49th," Luallen said.

Lawmakers have been successful at banning the sale of e-cigarettes to minors and making executive branch buildings and properties smoke-free.

Obesity

According to the State of Obesity report by the Robert Wood Johnson Foundation and Trust for America’s Health, Kentucky has the 12th-highest obesity rate in the country, at 31.6 percent.

By ranking, Kentucky has improved significantly from last year, when it landed at No. 5 nationally for obesity rates. But that’s deceiving. The state’s obesity rate has essentially leveled off, while other states have gotten worse.

And the outlook for obese youth isn't much better.

"Our youth obesity rate, however, showed an uptick, which is an indication of the importance of continuing our targeted efforts on this alarming health statistic," Luallen said.

Cancer and Cardiovascular Deaths

Luallen said cancer rates in the state have dropped from 207.4 people per 100,000 in 2010  to 201.2 people per 100,000 in 2012.

The state provided $1 million to expand screenings through the Kentucky Cancer Program in the 2014-16 budget, to increase breast and cervical cancer screening among Kentucky women.

Meanwhile, cardiovascular deaths dropped from 271.7 per 100,000 in 2011 to 260.3 per 100,000 in 2013, Luallen said.

She said the state has seen an increase in the percentage of adults being treated for high blood pressure, as well as those who received cholesterol screenings and enrolled in a smoking cessation program.

Dental Care for Children

Kentucky has seen an increase in the percentage of children ages 1 to 20 who have received dental services, from 48.3 percent of total eligible children in 2013 to 49.5 percent in 2014, according to the report.

"We've expanded the public dental hygiene program, and since starting the program, approximately 3,600 patients have been seen and over 2,000 services provided," Luallen said.

The report also shows a total of 162,326 adults in the Medicaid program received preventive dental services in 2014.

That is more than double the 74,866 served in 2013.

Reducing Drug Overdose Deaths

In 2014, nearly 15,000 Kentuckians in the Medicaid program received substance abuse treatment services, which is a newly covered essential health benefit under the Affordable Care Act, according to the report.

Data from the state's 14 community mental health centers show that 3,782 people with a substance disorder received services in 2014, and 5,517 were served in 2015. That's a 46 percent increase.

Luallen said the statistics show no progress.

"We stayed the same in poor mental health days and we actually lost ground in deaths from drug overdose, but the passage of Senate Bill 192, the landmark heroin legislation during the 2015 General Assembly session, should make a significant difference going forward," she said.

Luallen also cited the establishment of needle exchange programs in some parts of Kentucky — including Louisville — as a way to combat the growing problem of drug overdose deaths and high rates of Hepatitis C.