State Supreme Court hears arguments in Behsear's suit against new laws that would limit his emergency powers

By Ryland Barton
Kentucky Public Radio

The Kentucky Supreme Court heard arguments Thursday over the legislature’s attempt to limit Gov. Andy Beshear’s emergency powers, a day before the governor scheduled coronavirus restrictions are set to expire.

The Republican-led legislature passed several laws undermining the Democratic governor’s emergency powers earlier this year, including a measure limiting executive orders to 30 days unless renewed by lawmakers and requiring him to seek approval from the attorney general in order to suspend statutes during states of emergency.

Amy Cubbage, Beshear’s general counsel, argued that since the Kentucky constitution makes the governor the “chief executive,” the governor’s emergency powers are protected.

“This case is about whether the General Assembly can give itself—and others, including the attorney general and local governments—veto control over the exercise of emergency powers that reside and remain with the governor,” Cubbage said.

The Supreme Court ruled last year that Beshear has the power to respond to states of emergency largely unilaterally, without seeking approval for various orders and mandates from the legislature.

But after Republicans padded their majorities in the state legislature last year, GOP leaders made it a priority to try and strip Beshear’s powers during this year’s legislative session.

Beshear sued to try and block some of those measures: Senate Bill 1, limiting the governor’s emergency orders to 30 days unless renewed by the legislature; SB 2, giving the legislature more oversight over the administrative regulation process; and House Bill 1, allowing businesses to stay open during the pandemic as long as they follow federal—and not state—guidelines.

A lower court has temporarily blocked parts of those bills pending final action.

Republican Attorney General Daniel Cameron is defending the laws on behalf of the legislature, arguing the governor’s emergency powers aren’t enshrined in the state constitution and that lawmakers have authority to grant or take away powers.

Chad Meredith, Cameron’s solicitor general, argued there was no legal controversy in the case and that the governor was suing just because he didn’t like the new laws.

“The legislature can change the law. And that’s what they did. And now the governor has come before you and said ‘oh no, they can’t change the law. Once they give me this suspension power, it’s mine and you can’t take it away,’” Meredith said.

Justice Michelle Keller asked if Beshear’s loss of emergency powers would count as an injury that the governor could sue over.

“Can the harm not be the loss of something a governor or anyone once had? Because, as you stated, the General Assembly has curtailed or limited his executive authority. And so he once, before this session, did not have to check in with the attorney general when he wanted to suspend statute, now he does,” Keller said.

After the hearing Beshear held a short press conference. He said if the governor’s office didn’t have emergency powers during the pandemic, “we’d be in big trouble.”

“You look back at different things this legislature has tried to do in the midst of this pandemic, and they would’ve not had the courage to step up and mandate masks, which we know from the experts was absolutely necessary. We would’ve looked like the Dakotas and not what we looked like in Kentucky,” Beshear said.

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Health plans' campaign to get shots in arms moves to heart of Eastern Kentucky; each of five sites will offer ten $100 gift cards

Kentucky Health News adapted the state Department of Public Health vaccination map (click it to enlarge) to show counties in the "Shots Across the Bluegrass" tour. This week's are in boldface type.

At a different county health department in the heart of Eastern Kentucky each day this week, Kentucky's health-insurance companies will give away ten $100 gift cards to people who get a coronavirus vaccination.

The Kentucky Association of Health Plans, the lobbying group for companies offering health coverage in the state, said in its Friday press release that Visa gift cards would be given "while supplies last." Spokesman Tyler Glick said Sunday that each site would have 10 cards to hand out.

Each session will run from 9 a.m. to 2 p.m. ET, starting in Lee County in Monday. The "Vaccines for Visas" project will be in Owsley County on Tuesday, Breathitt County on Wednesday, Magoffin County on Thursday and Leslie County on Friday. Appointments are encouraged, but walk-ins are welcome.

KAHP Executive Director Tom Stephens said in the release, “We’re trying to reach those that have been sitting on the fence. This promotion will be raising awareness, which is half the battle.”

Last week, the group started its a “Shots Across the Bluegrass” vaccine tour with Kentucky Sports Radio broadcasts from five Kentucky counties, including stops in London and Manchester, near this week's counties.

Counties in the area have some of the state's lowest vaccination rates. In them, the percentages of the county population that has received at least one dose of vaccine are Laurel, 29%; Clay, 26%; Owsley, 28%; Lee (which has a state prison), 39%; Breathitt, 34%; and Leslie, 35%. The statewide vaccination rate is 48%; Woodford County is tops with 63%.

The health-plan group said its members are also using "digital and radio ads, member incentives, coordinated transportation for plan members, pop-up clinics, homebound vaccination visits, text and email campaigns, yard signs, billboards, outbound calls to members prioritized by risk tier, personalized assistance from advocates with sign-ups and digital site navigation, letters, and follow-up on second dose appointments if a plan is alerted that a member has not received the second dose based on claims data."

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Local collaborations help tackle Ky.'s health problems, and can be guided by hospitals' and health departments' needs assessments

By Melissa Patrick
Kentucky Health News

Collaborations in individual communities can play a critical role when it comes to improving Kentucky's poor health outcomes, largely because those outcomes are grounded in behaviors and unmet social needs at the community level.

That was the underlying message of the June 10 webinar hosted by the Foundation for a Healthy Kentucky, "Transforming Kentucky's Public Health System: The Critical Role of Community Collaborations." 

"There's a huge need for these coalitions because our health rankings are in the toilet and they've been in the toilet for quite some time," Ben Chandler, president and CEO of the foundation, told Kentucky Health News. "So much of the poor health resides in counties where they have lots of other issues." 

Those other issues are often called "social determinants of health" and include things like housing, transportation, food insecurity, education, healthcare and employment. Researchers have said they account for 80 percent of health outcomes. 

Kentucky ranked 48th for health behaviors and 46th for health outcomes in the last America's Health Rankings report from the United Health Foundation. 

Chandler noted that while the U.S. spends twice as much money on health care as other developed nations, it has worse outcomes. 

"So what it boils down to is, we've got to spend more of our resources working on changing people's behavior," he said. "And that sort of thing, I believe can only be done through public policy and at the community level; each community has to be involved." 

Many of these coalitions already exist in Kentucky, but Chandler said there is a need for more and a need to rejuvenate some that already exist. 

The Muhlenberg County Health Coalition is an example of one that is thriving. 

Jessica Browning, chairperson for the coalition, explained that this coalition was initially created to address the findings of the 2018 community health needs assessment of Owensboro Health Muhlenberg Community Hospital's, where she is the marketing director, and includes representatives from all sectors of the community. 

Tax-exempt hospitals like Muhlenberg must do community needs assessments every three years, under the 2010 Patient Protection and Affordable Care Act, with the expectation that they use them to create plans to address the identified community health needs. Some do, and some don't, but Chandler said they are a great tool to guide community collaborations.

Browning walked through several of the collaborative's initiatives, including efforts to make information about community and health resources easily available to the county's most vulnerable residents. The coalition also offers a community resource day twice a month, has found ways to address the county's homeless and housing issues, and has secured a grant to ensure affordable transportation for people who needed rides to work, school and medical appointments.

The Purchase Area Health Connections coalition in has also created a searchable database of resources in Kentucky's far west to make it easier for citizens to find the resources they need. 

Kaitlyn Krolikowski, network director of the coalition, said two of its largest initiatives are an opioid task force and a transitional care team of community health workers who work to reduce hospital readmission rates. CHWs are not health-care providers but educate people about care and help them get it.

The Purchase coalition's website shows that it also works on issues around childhood obesity, diabetes, mental health and more.

Krolikowski said the coalition formed when community members realized it would make the best use of their resources if everyone worked toward the findings of a regional community health needs assessment. She said the coalition's first meeting served as a "catalyst moment" to create different partnerships. 

Community collaborations have also been important to the state's local health departments, especially as it moves to a new model of operation, dubbed Public Health Transformation. 

Public Health Transformation was launched in 2019 and became law in 2020. Among other things, it establishes four "core public health" services that must be provided, those required by law or regulation. It also requires departments to do community health assessments, which many already do, to determine local health priorities beyond the core requirements. Those local priorities are funded separately. 

Jan Chamness, the state's Public Health Transformation project leader and director of the Division for Women's Health, said the transformation depends on strengthening partnerships in a community and allows health departments to collaborate with community partners to achieve their local priorities. 

For example, she said some departments have turned their women's health services and school health programs over to federally qualified health centers, clinics that get federal funds for meeting federal rules.

Public Health Transformation came about because of the fiscal instability of the health departments and because their services had evolved to not reflect their community needs, Chamness said. 

"What we're doing is not really working that well and so we really need to transform public health to be more responsive," she said.

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Local businesses can play a big role in getting rural customers and neighbors vaccinated for Covid-19; organizations offer help

Map by The Daily Yonder, adapted by Kentucky Health News

"A return to regular, small-town living will require a continuous effort to get residents vaccinated for Covid-19, according to the head of the Rural America Chamber of Commerce," Adilia Watson reports for The Daily Yonder. But do employers know how crucial they are to making that happen?

“A lot of business leaders, small business owners . .. see this as a critical issue,” Sherri Powell, the Rural Chamber’s executive director, said during the recent online National Rural Business Summit, which "explored outreach tools that business leaders, public health officials, and elected officials can use to share information in rural communities about Covid-19 vaccination," Watson reports.

Employers are important sources of information for their employees, and they can cut through medical and public-health terminology to “describe what science says in an accessible way,” said Maria Elena Castro, a health equity program analyst with the Oregon Health Authority. 

"As part of the online summit, the National Rural Health Association released a toolkit for communicating about vaccination in rural areas," Watson notes. The Health Action Alliance, which sponsored the event, has a checklist for rural employers who want to do more to educate workers and community members about coronavirus vaccination.

Without herd immunity, estimated at 70 to 80 percent of a population, “We will never get back to normal, even as small towns,” Powell said. “We can’t gather at the local baseball team’s games, or we can’t head into summer camp. These things are just not going to happen in a safe way until we take this seriously and get the shots.”

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Virus that was suppressed by pandemic measures resurges in Ky. and the South; main threat is to younger kids, vulnerable adults

The Centers for Disease Control and Prevention is advising people in Kentucky and states to the south to look out for a respiratory illness that is spreading in the region.

The disease is inter-seasonal respiratory syncytial virus.  RSV cases have been reported in Kentucky, Tennessee, Arkansas, Oklahoma, New Mexico, Texas, Louisiana, Alabama, Florida, Georgia, Mississippi and the Carolinas.

"Infants, young children, and older adults with chronic medical conditions are at risk of severe disease from RSV infection," the CDC said in an official health advisory Thursday. "Each year in the United States, RSV leads to on average approximately 58,000 hospitalizations with 100 to 500 deaths among children younger than 5 years old and 177,000 hospitalizations with 14,000 deaths among adults aged 65 years or older."

RSV was suppressed last winter, due to precautions taken to thwart the coronavirus, so "older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months," the CDC warns. "In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or apnea with or without fever."

Older children may have runny nose and decreased appetite, followed by cough, often followed by sneezing, fever, and sometimes wheezing, CDC says. Symptoms in adults are much like those caused by common cold viruses, and there is no specific treatment other than management of symptoms.

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Rural Ky. needs more community health workers and medical-school residents, legislators and UK hospital executive say

Chad Aull of the Kentucky Chamber of Commerce, upper left, moderated the webinar.

By Al Cross
Kentucky Health News

Improving health care and health in rural Kentucky will take more people in the health-care workforce, specifically at the top and bottom of the pay scale, two key legislators and one of the state's top hospital administrators said Tuesday, June 8.

Kentucky needs more health-care workers overall, because it may lose some to the pandemic, Mark Birdwhistell, vice president for health services administration at the University of Kentucky and chief of staff for UK HealthCare, said during a Kentucky Chamber of Commerce webinar on rural-urban health disparities.

"Coming out of Covid . . . many of our clinical workforce are fatigued, and they're second-guessing: 'Is this the career path that I want to go on?' They've been in combat for a year and a half now," Birdwhistell said.

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, agreed. "Burnout is real," she said, noting that her husband is a pulmonologist who has treated Covid patients.

The need for more community health workers, who are not health-care providers but can educate people about care and help them get it, came up as Birdwhistell, a former state health secretary, discussed the 2014 expansion of the federal-state Medicaid program for lower-income Kentuckians.

"Just because you've got coverage doesn't mean you've got access" to the health care you need, Birdwhistell said, because "Many providers don't take Medicaid." He and Baptist Health Louisville President Larry Gray said health insurance tends to cost more in rural areas due to lack of competition, so people buy policies with high co-payments and deductibles.

The expansion of Medicaid made clearer how the "social determinants of health" leave rural areas with lower health status, Birdwhistell said. It's twice as likely for someone in an urban area to finish high school or college as someone in a rural area, he said, so health literacy is lower in rural areas. And that extends to health insurance, he said, giving one example: "Deductible. That's hard to explain in English."

Moser, a retired nurse who chairs the state House Health and Family Services Committee, said expanding the limited government and commercial-insurance reimbursement for community health workers' services would help. "That is one policy that we're looking at possibly expanding," she said.

Birdwhistell said that would be "very, very cost-effective," because "In a lot of communities, people don't know how to access care, and they show up in the emergency room. And that is probably the worst place for anybody to show up with a high fever, strep throat, whatever. They don't get a continuum of care. . . . They will listen to somebody that they grew up with, somebody that they go to church with, somebody that they see on the soccer field with their kids."

The webinar also addressed the need for more doctors in rural Kentucky.

Birdwhistell said a major obstacle to getting more physicians in rural areas of the state are the limits on federally funded residency slots at the UK and University of Louisville medical schools. "Flipping that switch could pretty instantly change the number of professionals we have coming out," he said.

Republican Sen. Ralph Alvarado of Winchester, a physician, agreed, saying that residents tend to set up practices within 80 miles of where they do their residency. Moser also endorsed the idea.

Alvarado, chair of the Senate Health and Welfare Committee, noted that some rural areas have a shortage of health-care providers, which he blamed on state laws that make malpractice insurance expensive.

Gray said the shortage is especially bad in Eastern Kentucky, which needs providers who are willing to come to the region with "a sense of mission and vocation." But even with enough providers, transportation to get some patients to them is still an obstacle in some areas, he said. The expansion of telehealth has helped, he said, but some areas still lack internet access that is fast enough for it.

And even with telehealth, a shortage of specialists blocks care. For example, Kentucky has only 59 child psychiatrists, and half of them "are cash-only, don't take insurance," Alvarado said.

The panel started out by discussing some of the state's poor health statistics. Alvarado said the use of tobacco is heavier in rural areas, leading to all sorts of health issues, and obesity is more common, causing "more negative outcomes."

The news isn't all bad, he said, noting how Kentucky has raised its screening for colon cancer from 47th to 19th in the nation. "That's going to rub off on our death rates . . . in 10 years," he said. "There is some hope." But he also noted that screening rates in Eastern Kentucky remain relatively low.

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At last regular Covid-19 press conference, Beshear rescinds mask mandate and capacity limits, and more

Gov. Andy Beshear signs executive order to rescind state's mask mandate, capacity limits and other rules. Standing, from left, are Health Secretary Eric Friedlander, Cabinet Secretary J. Michael Brown, Chief of Staff LaTasha Buckner and Health Commissioner Steven Stack. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

In his last regular Covid-19 press conference, Gov. Andy Beshear lifted the statewide mask mandate for most settings, ended capacity limits for businesses and venues, and ended the state's "healthy at work" requirements, citing an ever-increasing number of Kentuckians getting a coronavirus vaccine as the reason these changes could be made. 

“Let me be clear, Covid-19 remains deadly. Our war against it is not yet won,” Beshear said Friday. “But after more than 15 months of struggle and of sacrifice, we can also say this: While Covid remains a threat, we are no longer in crisis.”

Later in theafternoon, the Kentucky Department of Education said in a press release that in line with the governor's executive order, it would rescind the state's "healthy at school" guidance as well, meaning that the use of masks and social distancing is no longer mandated. 

Beshear said he has held 250 Covid-19 news conferences Since the first one on March 7, 2020. Now, he said he will shift to a weekly news conferences, but on various topics. 

His executive order says masks are still required in high-risk places, such as public transportation, heath-care settings and nursing homes., and are recommended in correctional facilities, homeless shelters, and for anyone who is immuno-compromised or exhibiting symptoms of Covid-19 or has tested positive for it in the previous 10 days.  

Beshear said any business that wants to continue requiring masks can do so, and called on Kentuckians to be patient with one another as people work through these changes. 

Beshear spent many minutes recounting the state's 15-month fight against the coronavirus and thanking his team and other Kentuckians for hard work and many sacrifices, saying they allowed the state to beat back three waves of infection and avoid having its hospitals overrun with Covid-19 patients. 

"We know that our actions saved thousands, likely tens of thousands, of lives," he said. Later, he said, "I think we've done more things right than most states."

Some Republican state senators said Thursday that Beshear should also end the state of emergency that gives him special powers. He told Louisville's WLKY-TV that he would probably maintain the emergency as long as the federal government does, to take advantage of possible federal aid.

Kentucky Health News asked Beshear what what he would say to those who think the pandemic is over. He didn't directly answer, instead thanking those who were vaccinated, saying their risk is very low. To the unvaccinated, he said the state has shared plenty of information about the vaccines and it is now up to them. 

"If you are not vaccinated, we have talked over and over and over about how to protect yourself from this virus and you've had the personal choice now either to get the protection of the vaccine, or to take the steps that we know can protect you," he said. "So to everybody out there, just do right thing." 

Health Commissioner Steven Stack reported that since vaccines became available in January, coronavirus cases have declined 93 percent, Covid-19 hospitalizations 83% and deaths 95%.

Washington Post chart

More than 2.1 million Kentuckians have received at least one dose of a vaccine, or 47% of the total population. Centers for Disease Control and Prevention data show 55.8% of the eligible population, 12 and up, is fully vaccinated.

Last week Kentucky opened up a lottery-style incentive for people with at least one dose. It will give three Kentuckians $1 million each and 15 students higher-education scholarships. Beshear said about 370,000 people have registered for the drawings at shotatamillion.ky.gov. The first drawing will be July 1; registration covers all three drawings. 

On Thursday, the Kentucky Supreme Court heard arguments in two cases involving legislation seeking to limit Beshear's emergency powers to enact pandemic restrictions, Joe Sonka reports for the Louisville Courier Journal.

"The oral arguments came just one day before Beshear is set to repeal emergency regulations on limiting venue capacity and the wearing of masks, which were challenged by two restaurants and a brewery in one of the cases before the state's highest court," Sonka writes.

Daily numbers: In his final such report, Beshear announced 237 new cases of the coronavirus, bringing the seven-day rolling average to 284, the lowest in just over 11 months. 

The share of Kentuckians testing positive for the virus in the past seven days is 2.05%.

The statewide rate of daily new cases is 4.29 per 100,000 residents. Counties with rates more than double that level are Webster, 35.3; Mason, 14.2; Rockcastle, 12; Rowan, 11.7; Bath, 11.4; Estill, 11.1; Marion, 11.1; Franklin, 10.9; Harrison, 10.6; Allen, 10.1; Fleming, 9.8; Todd, 9.3; Green, 9.1; Hopkins, 9.0; Union, 8.9; Muhlenberg, 8.9; Knox, 8.7; and Metcalfe, 8.5.

Kentucky hospitals reported 270 Covid-19 patients, with 72 in intensive care; and 35 of those on a ventilator, continuing a long downward trend. 

Two of the state's hospital readiness regions are using at least 80% of their intensive-care beds: the easternmost, from Lee to Pike counties, at 80.15%; and Lake Cumberland, at 88.89%. 

The state reported nine new Covid-19 deaths, bringing the state's death toll from the disease to 7,147. Beshear said only one was not vaccinated, roughly reflecting the vaccines' 90% or greater effectiveness. He said the larger-than-average number of deaths the last two days (12 and 17) reflected old cases that needed additional documentation for confirmation. The state is averaging about 7 Covid-19 deaths per day.

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