The5th meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 19, 2008, at 1:00 PM, in Room 131 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order 1:12 PM, and the secretary called the roll.
Members:Representative Tom Burch, Co-Chair; Senators Denise Harper Angel, Alice Forgy Kerr, Joey Pendleton, Dan Seum, Katie Stine, and Johnny Ray Turner; Representatives James R. Comer, Jr., Bob M. DeWeese, Joni L. Jenkins, Reginald Meeks, Darryl T. Owens, Ruth Ann Palumbo, David Watkins, and Addia Wuchner.
Guest Legislators: Representatives Jimmie Lee and Dottie Sims.
Guests: Dr. Judy Monroe, State Health Commissioner, Indiana State Department of Health; Dr. Michael Karpf, Executive Vice President for Health Affairs, University of Kentucky; Karen Cassidy, State President, and Jim Kimbrough, Issue Specialist for Long-Term Care, AARP; Joan Smith, Director, Lifehouse Center; Timothy Veno, Kentucky Association of Homes and Services for the Aging; Claude and Betsy Farley, Parents and Relatives of Oakwood Residents; Eric T. Clark, Kentucky Association of Health Care Facilities; Ellen Kershaw and Jaime Gill, Alzheimer’s Association; Sheila Schuster, PhD, Co-Chair, Rich Seckel, Co-Chair, Patrick Jeffreys, Project Director, Kentucky Voices for Health; Bruce Begley, Executive Director, and J.A. Logan, Medical Director, Methodist Hospital, Henderson; Patty Dempsey, The Arc of Kentucky; Karen Thomas Lentz, Johnson & Johnson; Anne Joseph, Covering Kentucky Kids and Families and Kentucky Task Force on Hunger; Amy Barkley, Campaign for Tobacco Free Kids.
LRC Staff: DeeAnn Mansfield, CSA; Mike Bossick, Miriam Fordham, Ben Payne, Gina Rigsby, and Jonathan Scott.
A motion to approve the October 15, 2008 minutes was made by Senator Kerr, seconded by Representative Wuchner, and approved by voice vote.
Senator Stine, Co-Chair, Families and Children Subcommittee, reported the subcommittee met that morning and heard a presentation involving school nutrition by Paul McElwain, Director of the Division of Nutrition and Health Services, Department of Education. Pam Goins and Jennifer Ginn, Education Policy Division, The Council of State Governments, informed the subcommittee about the national School Lunch Program and the School Breakfast Program. The subcommittee heard testimony from Shane Tucker, Federal Program Manager, Office of Local Program, Transportation Cabinet, about the five programs of the Office of Local Programs. The subcommittee also heard a presentation on teen suicide in Kentucky from Dr. Hatim Omar, Department of Pediatrics, University of Kentucky. A motion to accept the report was made by Senator Stine, seconded by Representative Meeks, and accepted by voice vote.
Senator Harper Angel, reported the Health Issues Subcommittee met that morning and heard testimony on the Kentucky HIV Planning and Advisory Council (KHPAC) 2008 Year-End Report by Robert Edelen, Chair, Care and Prevention Committee. Deborah Wade, MSW, Program Director, WINGS Clinic, Ryan White Parts C & D, University of Louisville, gave a presentation on trends seen in HIV/AIDS patients treated at the Louisville clinic. The subcommittee also heard a presentation from Dr. Ruth Ann Shepherd, Division Director, Division of Maternal and Child Health, Department for Public Health, Cabinet for Health and Family Services. A motion to accept the report was made by Senator Harper Angel, seconded by Senator Kerr, and accepted by voice vote.
A presentation on tobacco prevention and cession programs was given by Dr. Judy Monroe, State health Commissioner, Indiana State Department of Health. Dr. Monroe stated that tobacco is the single most preventable cause of death in the United States. According the 2007 BRFSS, Kentucky has the worse rate of adult smokers nationwide. Nicotine is as addictive as heroin or cocaine, and 70 percent to 90 percent are addicted to nicotine. Approximately 90 percent of people addicted to nicotine started smoking as teenagers. She said that approximately 83 percent of smokers say they would not smoke if they could do it over again. The reasons smokers regret starting are health, expense, addiction, disgust, and stigma. She stated that the Centers for Disease Control and Prevention (CDC) best practices on tobacco prevention and cessation are state and community intervention; health communication interventions; cessation interventions surveillance and evaluation; and administration and management. The CDC best practices on state action on tobacco-use treatment should include the following elements: 1) Sustaining, expanding, and promoting services available through population-based counseling and treatment programs including quitlines; 2) Covering treatment for tobacco use under both public and private insurance including both counseling and medication; 3) Eliminating costs and other barriers to treatment for underserved populations, particularly the uninsured; and 4) Making the healthcare system changes recommended by the clinical practice guidelines.
Senator Kerr asked about the Quitline. Dr. Monroe said that a Quitline is telephone-based cessation services offered toll-free to the general public, is evidence-based, and reactive or proactive.
Representative Lee asked if data was available that supported Indiana youth stopped smoking because of the increase in the cigarette tax or did they go across state lines to buy products. Dr. Monroe stated that a small percentage did go other places, but nationwide a ten percent increase in the cigarette tax showed a seven percent decrease in youth smoking. He asked if Indiana’s program had not been in place long enough to obtain sufficient about cigarette taxes and youth smoking, and she said this was correct. He asked if the cessation program would pay for pregnant women to use nicotine patches, and she said not through the Quitline. He asked if Medicaid would pay for the nicotine patches, and she said, yes, if a doctor prescribed one for a patient.
Representative Meeks asked how hard it was to get the support of the legislature for the tobacco prevention and cessation program. She stated that the Governor supported it and she reached out to community partners to get them to spread the word that this legislation was important and needed to be passed because it would improve the health of the citizens of Indiana.
Senator Harper Angel asked about the difference between the Quitline and the Enhanced Quitline. Dr. Monroe stated that the Quitline is for non-pregnant women who will receive four counseling sessions. The Enhanced Quitline is for pregnant women and allows ten counseling sessions.
Representative Meeks asked about the funding for community-based grants. Karla Sneegas stated that a grant could be anywhere from $20,000 to $250,000 based on the community. He asked which programs were funded, and she said program recommended by the CDC.
Representative Jenkins asked if there were in youth programs in the middle and/or high schools. Ms. Sneegas stated that they work with school districts to have tobacco-free campuses following CDC comprehensive guidelines. Ms. Sneegas said the great need and main focus is on the ninth graders.
Representative David Watkins, Dr. John Logan, Medical Director, and Bruce Begley, Executive Director, discussed the angioplasty procedures at Methodist Hospital in Henderson. Representative Watkins stated that currently, patients who heart problems have to be transferred to another hospital, because CON prohibits interventions in Henderson. He said that technology has changed immensely. Representative Watkins and Dr. Logan stated that they want the ability to give patients the care they are qualified to provide. Dr. Logan stated that only two institutions in Kentucky cannot provide angioplasty and that is Henderson and Hopkinsville.
Dr. Michael Karpf, Executive Vice President for Health Affairs, University of Kentucky, gave a presentation on growing to serve the health care needs of Kentuckians, Creating Jobs for the Commonwealth. Dr. Karpf stated the mandate from the General Assembly for the University of Kentucky was to become a top 20 public research institution. The slow but steady decline in clinical activity within the organization had to be addressed for the organization to maintain the relevance in the health care marketplace of the Commonwealth. The Strategic Planning consisted of advanced subspecialty care – Level 1 Trauma Center, regional care – allowing patients to remain close to home and utilize local services, and efficiency, quality, and patient safety – Center for Enterprise Quality and Safety established to focus on the development of efficient processes aimed at optimizing clinical outcomes and the safety of patients. He stated that the clinical outreach network has created a strong foundation for the virtual network. With relationships with community hospitals and physicians, they now have nearly 150 clinical outreach practices and linkages to approximately 4,500 beds. Dr. Karpf stated that geographical expansion is critical to ensure access to a large enough population to support advanced subspecialty care. From fiscal year 2004 through fiscal year 2013, the anticipated investment in the clinical enterprise will exceed $1.6 billion. This investment will be completely self-funded through operations and bond issues.
A presentation on Lifehouse Center was given by Joan Smith, Executive Director. Ms. Smith stated that Lifehouse is a maternity home in Louisville. Lifehouse’s mission statement is to provide for the spiritual, emotional, physical, and intellectual needs of pregnant and or parenting teens and women and their child – both born and unborn – in a Christ-centered home environment. She said that she wants criteria and the definition of a maternity home established so young pregnant mothers can reach their full potential and give birth to a healthy baby. Right now it meets all the Louisville standards of a group home. A maternity home should be able to welcome any young girl or woman, who is pregnant and in need of help, regardless of age.
When a young woman seeks help at Lifehouse, she has already decided to carry her baby to full term and is in need of assistance. Lifehouse was opened in April 2007, and is already at capacity on one out of every ten girls that inquire will come into the program because there are rules and regulations. The rules and regulations are strict to help the girls meet goals. These young women are not wards of the state and come for different reasons such as being overwhelmed, financially strained, in need of medical care, or simply being embarrassed by their situation. Lifehouse has medical care, counseling, schooling, good nutritional programs, mentoring programs, job placement, financial planning, nightly classes, and continuing support for up to three years after delivery. Lifehouse staff consists of a R.N., a social services director, a PhD therapist, a Seven Counties counselor, and retired teachers and social workers who serve as house moms. All residents, staff, and volunteers have criminal history background checks. She said that $100,000 has been donated for college education and all medical needs are provided pro bono. All girls must be in school, or if they have their high school diploma or GED, they must have a job. All funds raised for Lifehouse have come from private sources.
Senator Harper Angel asked about the spiritual aspect of the program. Ms. Smith said that part of the program is to help the girls see their spiritual side and they are encouraged to attend church services, but they are not affiliated with any church.
A presentation on Kentucky Voices for Health, Building a healthy Kentucky together, was given by Sheila Schuster, PhD, and Rich Seckel, Co-Chairs, and Patrick Jeffreys, Project Director, Kentucky Voices for Health. Kentucky Voices for Health is a coalition of concerned Kentuckians who believe that the best healthcare solutions are found when everyone works together to build them. They are supported by a grant from the Public Welfare Foundation to the Foundation for a Healthy Kentucky, given to support the Foundation’s work with a coalition of advocates to expand health coverage in the public and private sectors, identify revenue sources to support public health care programs, and build the capacity of consumers to advance health care reform in Kentucky. Right now, families and businesses in every county are facing rising costs, and too many of us go without needed health care. Healthy families create healthy economics, and a healthy Kentucky is something we all want. The coalition’s goal is to reduce the number of Kentuckians without health insurance or health coverage. The 2005 Census data show that the numbers are growing. Kentucky Voices for Health initiatives for 2008-2009 are to 1) significantly increase the tobacco tax to reduce smoking and improve health; 2) enroll and expand public sector health coverage to children and families; and 3) expand health coverage in the private sector for young adults.
Representative Burch stated that Kentucky needs a universal health plan.
A presentation on AARP: Long-Term Care was given by Karen Cassidy, RN, MSN, EdD, Volunteer State President, and Jim Kimbrough, Volunteer Issue Specialist for Long-Term Care. Ms. Cassidy stated that projections show that by the year 2030, the 60+ population will be 1,287,999 persons, representing 26.2 percent of the population. Today, Kentucky is ranked 27th in the nation in the proportion of our population over age 65, and in 2025, Kentucky is projected to be 14th in the nation. As the population continues to age, so will the needs and demands for human services. A large number of these persons will be some of our state’s most vulnerable citizens. These individuals will present a challenge to our state’s increasingly limited resources, both economic and human. To meet even the most basic human needs, our state must be forward thinking and find new strategies to meet these demands. The current long-term care system cannot fully meet today’s needs and does not offer enough options for seniors. Some seniors need nursing home care, but they also deserve choices.
Ms. Cassidy said that an individual should have the option to remain in their home. An individual should not have to spend down all of their resources to enter a nursing facility just to receive services they could receive at home, which is not possible at the present time. Kentucky’s aging services budget has received only one small increase in 15 years. There are 7,000 older Kentuckians that need state services. The services include home-delivered meals, someone to assist them with bathing and dressing, or life-supporting transportation. Currently, these 7,000 older adults receive no services from the state. There are 7,800 older adults receiving some help, but they actually need additional help to stay in their homes. The annual cost of living in a nursing home for one individual under Medicaid is approximately $35,000. The cost for the same individual to remain at home under the Medicaid Home and Community Based Waiver is an average of $5,000 per year. Kentucky faces significant fiscal and policy challenges, and we need to take a hard look at long-term care in Kentucky. The old ways of providing services for our elderly will not work. In a recent study, more than 80 percent of older Kentuckians said they would prefer to remain in their own homes now. The state budget cannot afford to institutionalize five million Kentucky baby boomers in the future.
There being no further business, the meeting was adjourned at 2:58 p.m.