Feds propose rules to limit junk health plans to 4 months keep them from 'gaming the system'; seek info on health credit cards

By Jennifer Shutt
States Newsroom

The Biden administration announced new initiatives Friday that could reduce health-care costs, though none will take effect immediately.

The changes include a proposed rule that would reduce the amount of time short-term health-insurance plans can last, and requirethe plans to be more transparent about what is covered and what isn’t.

Also, the White House is seeking information about high-interest-rate credit cards that doctors’ offices offer to help people pay for their care, and telling hospitals that patients are either in-network, with billing limitations in the Affordable Care Act, or out-of-network, with costs covered by a more recent law, the No Surprises Act.

White House Domestic Policy Advisor Neera Tanden told reporters Thursday that the proposed rule, which could be finalized later this year, would help Americans to understand the difference between health insurance offered under the Affordable Care Act and what she called “junk insurance.”

Those short-term plans, Tanden said, “are intended to provide temporary coverage as people transition from one source of coverage to another, like when we’re between jobs,” but during the Trump administration, the plans were allowed to last as long as three years, she said.

Tanden said the short-term plans have left some people with thousands of dollars in medical debt, including a Montana man who had $43,000 in medical bills after a short-term plan denied him cancer coverage by saying it was a pre-existing condition.

The proposed rule would limit short-term plans to three months with a one-month renewal option, and “require plans that discriminate based on pre-existing conditions and don’t offer comprehensive benefits to disclose their limits clearly to consumers,” Tanden said.

Unexpected medical bills

On surprise medical billing, the Department of Health and Human Services is sending guidance to hospitals that Biden administration officials hope will reduce or eliminate people receiving thousands in medical bills they did not expect.

“We’re making it clear that plans and providers cannot evade surprise billing rules simply by changing the terms they use in their contracts,” Tanden said. “Some health plans contract with hospitals, then try to claim that they are not technically ‘in network.’ Frankly, what they are doing is gaming the system. This is not allowed and, as our guidance will describe, it must end.”

A senior administration official, speaking on background to describe details of the guidance, said it should clarify that there is no space between the protections for out-of-network costs covered under the federal law known as the No Surprises Act, or protections in the Affordable Care Act for in-network costs.

“We are saying there is no gray area here,” the official said. “It is either the protections of the No Surprises Act, or the protections for out-of-pocket costs.”

The other initiative from the administration unveiled Friday requests information from the public about credit cards and certain types of loans that are often offered to people to help them pay for health care.

Tanden said people signing up for such cards may not understand how they work because they “often include teaser rates and deferred interest features that lead to higher costs for consumers.”

A second senior official, also speaking on background, said the cards often have interest rates that are much higher than a regular card. They are sometimes offered to patients in a health-care provider’s office.

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5 cases of Legionnaires' disease reported in Lexington prompting health officials to urge caution around pools and hot tubs

Centers for Disease Control and Prevention graphic

By Melissa Patrick

Kentucky Health News

The Lexington-Fayette County Health Department announced Thursday that it has seen an increase in Legionnaires' disease this year and is warning people to take caution around outdoor pools and hot tubs, since the disease is spread when people breathe in small droplets of water that contain the bacteria that causes it. 

"The increase of use of outdoor pools and hot tubs during the summer, combined with recent rainfall and the potential for stagnant water, creates a need for reminders about Legionnaires’ disease," the department said in a news release. 

Kevin Hall, spokesperson for the department, told Kentucky Health News that five cases of the disease have been reported and that they typically don't have any. He added that they were still investigating the sources of the infections and that it is still unknown whether the cases ae related. 

Legionnaires' disease is a very serious type of pneumonia caused by Legionella pneumophil bacteria. The bacteria can also cause a less serious illness called Pontiac fever.

"Legionella occurs naturally in freshwater environments, like lakes and streams. It can become a health concern when it grows and spreads in human-made building water systems," the release says. 

For example, the Centers for Disease Control and Prevention says it can grow in shower heads and sink faucets, cooling towers, hot tubs, decorative fountains and water features, hot-water tanks and heaters and large, complex plumbing systems like those found in hospitals, hotels and cruise ships. (It was discoveerd after an outbreak at a Philadelphia hotel durign an American Legion convention.)

The health department adds that swimming pools become a concern when the temperature sits within the danger zone for the growth of the bacteria: "Legionella are unlikely to grow in typical swimming pools because water temperatures are usually too cold. However, you should sample pools if they are associated with a possible exposure or temperatures are within the permissive range (i77 to 113°F )." 

Health officials say the disease is generally not spread from person to person, but that is possible under rare circumstances. 

People at higher risk of getting Legionnaires' disease are those 50 and older, those with chronic lung disease, current or former smokers, those who take drugs that suppress their immune system, and people with cancer or underlying illnesses like diabetes, kidney failure or liver failure. 

The CDC urges people to talk to their doctor or local health department right away if they think they have been exposed to Legionella or if you develop pneumonia symptoms, such as fever, cough, chills or muscle aches. And, to be sure to mention if you have spent any nights away from home in the last 14 days. 

The health department says public-health agencies reported nearly 10,000 cases of Legionnaires’ disease in the U.S. in 2018, but thie actual number was likely much higher because the disease often goes undiagnosed: "A recent study estimated that the true number of Legionnaires’ disease cases may be 1.8–2.7 times higher than what is reported."

In Kentucky, 606 cases of  Legionnaires' disease (both confirmed and probable) have been reported since 2018, with an average of 114 cases a year between 2018 and 2021. In 2022, the state reported 107 cases, which are still being reconciled, and so far, 43 cases have been reported in 2023.  

While the disease is uncommon and most people make a full recovery, it can be deadly. According to the CDC, most people who get Legionnaires' disease need  hospital care, and about one out of every 10 people who get the disease die from complications of the illness.

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First drug to slow Alzheimer's disease gets full FDA and Medicare approval for mild cases; drug is still in clinical trials at UK

By Melissa Patrick
Kentucky Health News

The U.S. Food and Drug Administration has granted full approval for the first drug to slow down the progression of Alzheimer's disease, opening the door for Medicare to pay for it.

"This is the first medicine ever that actually changes the disease in the brain, removes a component of the disease and can extend quality of life for patients who are developing and who are in the early stages of Alzheimer’s disease," Dr. Greg Jicha, director of clinical trials at the University of Kentucky Sanders-Brown Center on Aging, said at a news conference on Friday. 

Jicha stressed that the drug is not a cure, but instead has been shown in clinical trials to slow the disease process by 27% to 40%. 

Lecanemab, marketed by the Japanese pharmaceutical company Eisai and its U.S. partner Biogen under the brand name Leqembi, is an antibody that targets amyloid plaques, which are found in the brains of people with Alzheimer's. It is administered twice monthly through intravenous infusion and the companies have estimated treatment will cost $26,500 a year. 

The drug has been on the market since January 2023 under an accelerated approval from the FDA but was not broadly covered by Medicare. Following the FDA's full approval of the drug, Medicare, which primarily serves adults age 65 and older, will now cover it for those who qualify. 

Before the Centers for Medicare and Medicaid Services made that announcement, Jicha said the approval would make coverage more likley by other insurers, including Medicaid, which is a federal-state program.

Jicha also said he hopes Esail will have patient-assistance programs to ensure that anyone who qualifies for the drug has access to it. 

“I really think it behooves all of us to ensure that this medicine is accessible to everybody,” he said. “No matter what their socioeconomic status, no matter what their geographic limitations are, everyone who has early Alzheimer’s disease deserves the opportunity as long as the medicine is going to be safe for them.”

Dr. Jim Jackson of Morehead receives an infusion of 
lecanemab at the UK Sanders-Brown Center on Aging. 

Dr. Jim Jackson, a retired pediatrician from Morehead, participated in an 18-month lecanemab study at UK and is now part of what his wife, Sharon, called an "extension study." 

"I felt that it was really a good opportunity to be part of something that can improve life for many, many people," he said at the news conference. Later adding, "I would be very happy to recommend this drug. I've been tickled to death to be in the study." 

Jicha said there are some side effects to the drug, including amyloid-relating imaging abnormalities (ARIA), typically a temporary swelling and/or bleeding in certain areas of the brain that usually resolve over time. He said people with two copies of a well-known Alzheimer's risk gene may be more at risk of ARIA. 

Sharon Jackson said her husband has responded well to the drug and has had no side effects. When he started the clinical trial, she said, "Jim had a little bit of memory issues and I can plausibly say that it has not progressed very much. . . . I can see that this medication, from what I understand about Alzheimer's, seems to be holding him pretty steady."

Who qualifies for the drug?

The medication will only be available to those in the early stages of the disease, and doctors willhave to verify that there is a buildup of amyloid in the brain before they can prescribe, Jicha said. Also, he said the drug must be administered by specialists who understand how to provide the treatment and to monitor for safety. 

“This medicine is only for those with mild memory problems, what we call mild cognitive impairment or folks that are in the mild stage of Alzheimer’s,” Jicha said, because benefits are uncertain for those in “a more moderate or severe stage.”

The drug is not available to people at risk of Alzheimer's, but Jicha said ongoing clinical trials are evaluating the usefulness of the drug for this group.   

The Alzheimer's Association promoted early detection and diagnosis in its press release celebrating the full approval of lecanemab. 

"With this approval, early detection and diagnosis are even more critical to ensure individuals receive the most benefit at the earliest point possible. If you or a loved one is experiencing memory changes, the Alzheimer’s Association strongly encourages speaking with a health care provider for a thorough evaluation and diagnosis and to discuss treatment options," says the release. 

In Kentucky, 75,000 people aged 65 and older are living with Alzheimer's and that number is expected to increase by 15% in the next few years, to 86,000  in 2025, according to the Alzheimer's Association. Further, the association says 11.2% of people aged 45 and older have subjective cognitive decline.

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Take care of your teeth help your mind: Study finds keeping teeth with severe gum disease is associated with atrophy of the brain

Taking care of your teeth could also mean taking care of your brain. A study published today says gum disease and tooth loss are linked to shrinkage in the hippocampus, a part of the brain that "plays a role in memory and Alzheimer’s disease. The study does not prove that gum disease or tooth loss causes Alzheimer’s disease; it only shows an association," says the American Academy of Neurology, which published the study in its journal, Neurology.

“Tooth loss and gum disease, which is inflammation of the tissue around the teeth that can cause shrinkage of the gums and loosening of the teeth, are very common, so evaluating a potential link with dementia is incredibly important,” said study author Satoshi Yamaguchi of Tohoku University in Sendai, Japan. “Our study found that these conditions may play a role in the health of the brain area that controls thinking and memory, giving people another reason to take better care of their teeth.”

The researchers studied 172 people with an average age of 67 who reported no memory problems at the beginning of the study, when they had dental examinations, memory tests and brain scans to measure volume of the hippocampus. Another scan was done four years later.

"After adjusting for age, researchers found that for people with mild gum disease, the increase in the rate of brain shrinkage due to one less tooth was equivalent to nearly one year of brain aging," the AAN reports. "Conversely, for people with severe gum disease the increase in brain shrinkage due to one more tooth was equivalent to 1.3 years of brain aging."

Yamaguchi said, “These results highlight the importance of preserving the health of the teeth and not just retaining the teeth. The findings suggest that retaining teeth with severe gum disease is associated with brain atrophy. Controlling the progression of gum disease through regular dental visits is crucial, and teeth with severe gum disease may need to be extracted and replaced with appropriate prosthetic devices.”

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DEA administrator says Congress needs to pass laws to keep social media from serving as platforms to promote sell fentanyl

The U.S. needs laws to force social-media companies to keep their platforms from being used to promote and sell fentanyl, DEA Administrator Anne Milgram said on NBC's “Meet The Press” Sunday, in a program that was devoted entirely to the drug and the problems it is causing. Just over half of teh 2,135 drug overdoses in Kentucky last year involved fentanyl, a very powerful opioid.

“The border’s an important part of this conversation because most of the fentanyl that we see coming into the United States is coming in through the southwest border,” Milgram said, but “Social media is also a vital part of the conversation. It is what I call the last mile. Because what the cartels need – they’re selling the deadliest poison we’ve ever seen – they need that to … be able to expand and sell more, they need to be able to reach people at massive rates. And that’s what social media’s doing,” The Daily Wire reports.

Host Chuck Todd asked Milgram asked if social-media companies were cooperating with federal law enforcement in trying to fix the problem. She said, “We have not, until recently, gotten nearly as much cooperation as we need. . . . The deputy attorney general convened all of us in April of this year and made it very clear, number one, that the companies have to comply with their own terms of service, which say, ‘This is illegal. You cannot be selling fake pills. You cannot be selling drugs on social media websites’.”

Milgam also said law enforcement needs to be able to get information from social-media companies. Asked if there was something the DEA does not have that Congress could give them that would help them address the issue, she said, “So we talk a lot with Congress about social media. We talk a lot about the need for these platforms – essentially, one of the main ways we see Americans dying right now is through social media, the purchase of pills, fake pills on social media. So, again, if we’re after, how do we stop 110,000 Americans from dying?” She said Congress was “a place to start.”

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Kentucky has 84 syringe-service programs in 65 counties; the pandemic slowed their growth but two have opened this year

State Department for Public Health map, adapted by Kentucky Health News; click on it to enlarge.

By Melissa Patrick

Kentucky Health News

Kentucky has added two new syringe-service programs for intrevenous drug users this year, bringing the total to 84 SSPs, in 65 of the state's 120 counties. Hart County opened its program in January and Estill County reopened its program in April.

SSPs are part of what health departments call “harm reduction programs,” which offer a host of strategies to minimize the negative physical and social impacts of drug use. They are also called syringe-exchange programs or needle exchanges, for the best-known element of the prorgams.

Estill County's program reopened after being shut down in 2020 because the Irvine City Council took away its approval, required by state law in a city where a program is based. The Estill County Health Department's program is now in a mobile clinic that goes to multiple locations in the east-central Kentucky county. 

Hart County is in south-central Kentucky, which is served by the Barren River District Health Department. Charity Crowe, a UK Healthcare health-education coordinator embedded in the department's harm-reduction program, told Kentucky Health News that adding more SSPs to decrease overdose deaths is one goal of the Barren River Initiative to Get Healthy Together (BRIGHT) Coalition.

Only three of the 10 counties in the district have SSPs. Warren County opened its program in 2016, Barren County in 2018, and Hart County in January. 

Crowe said one of the first steps they took as they worked to get local approvals in Hart County was a survey of local jail inmates, asking f they would use an SSP if it was available. She said 63 inmates, or 64% of the survey respondents, said they would use it.  

"That kind of helped us with getting everything passed through the Board of Health, Fiscal Court and City Council," Crowe said. She praised the efforts of County Judge Executive Joe Choate: "He was a huge supporter of the program and us getting it started, so that helped get everything moving along a lot quicker."

Asked if she had any advice for people in the 55 Kentucky counties that still don't have an SSP, but want one, she said it's important to keep educating people about what they are and why they are important. 

"Just to try to educate people on why we do what we do," Crowe said. "There's so much stigma surrounding the things that we do with harm reduction. . . . We are trying to make our communities a safer place, not just for people that use drugs, but for our kids, our first responders, everybody." 

She also encouraged them to not give up. "Pretty much anywhere that you go, you will get a little bit of pushback," she said. "But in order for us to break that stigma, we just have to keep educating people."

Looking to other counties in the district, Crowe said they have held an educational meeting in Edmonson County and are working to have one in Logan County. She said Logan County's health board of health and Russellville City Council have approved an exchange, but the Fiscal Court has not.

Kentucky Health News graph from state data; click to enlarge.

The steady growth of SSPs in Kentucky took a heavy hit from the pandemic, with only eight counties opening a new SSP since 2020. The legislature authorized the programs in 2015.

Syringe-service programs not only exchange clean needles for dirty ones, to decrease the spread of blood-borne diseases like hepatitis C and HIV, but provide education on the safe use and distribution of wound-care kits and Naloxone, which blocks a drug overdose. Other services are infectious-disease screening, vaccinations, and linking people to housing, food access, insurance, medical care, substance-use treatment and behavioral-health services.

Crowe said the SSPs in Hart and Warren counties also use a peer-support specialist who has "been a phenomenal resource for our clients." 

On June 29, a new law kicked in that decriminalized fentanyl test strips in Kentucky, meaning they will no longer be considered drug paraphernalia in the state. Because of this, Kentucky's SSPs can offer them to their clients. Fentanyl was involved in 72.5% of the state's 2,135 overdose deaths in 2022. 

Fentanyl test strips are paper strips that can detect the presence of the powerful opioid in pills and other drugs within minutes. They are considered a low-cost method of helping prevent drug overdoses and reducing harm, according to the Centers for Drug Control and Prevention.

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State's first detailed report on domestic-violence cases has a wealth of data on how courts and law enforcement handle it

The domestic-violence report's data on courts is by area development district, not by judge or county, but it has data on how individual law-enforcement agencies served emergency protective orders.

Kentucky Health News

"Kentucky has long had a problem with domestic violence," the Lexington Herald-Leader reports. "A 2012 survey found that 45% of women and 35% of men" in the state have been victims of domestic violence, sexual violence or stalking, "according to a new report released Friday, marking the first time the commonwealth has ever tracked the data. Now the commonwealth will begin to dig into the details with a debut domestic-violence report that will set a baseline for police reports, protective orders issues, court cases and other information."

The report has a wealth of information about how domestic violence is handled by courts and law-enforcement agencies at regional and local levels. It covers the 14,199 charges and 8,867 arrests related to domestic violence in 2022, and the outome of the 19,986 petitions courts received for emergency protective orders in criminal and civil cases.

For example, it gives the average number of days that it takes individual law-enforcement agencies to serve EPOs on people accused of domestic violence or threats of violence, based on reports by the agencies. Statewide, the average is 2.22 days, but in many counties, especially in Appalachian Kentucky, service is much slower, perhaps putting potential victims at greater risk.

Law-enforcement agencies that averaged 10 days or more (excluding those with fewer than 10 EPOs served) to serve EPOs were: Adair County sheriff (12 days), Bell County sheriff (13), Breckinridge County sheriff (12), Calloway County sheriff (14), Corbin Police Department (19), Garrard County sheriff (15), Laurel County sheriff (10), Lawrence County sheriff (11), Martin County sheriff (11), McCreary County sheriff (15), Perry County sheriff (10), Rockcastle County sheriff (15), Spencer County sheriff (13), Wayne County sheriff (10), Whitley County sheriff (12), Williamsburg Police Department (10); and Wolfe County sheriff (13).

Agencies that averaged 7 days or more (excluding those with fewer than 10 EPOs served) were: Anderson County Sheriff's Department (8 days), Danville Police Department (8), Estill County sheriff (9), Fayette County sheriff (7), Franklin County sheriff (7), Grayson County sheriff (7), Harrison County sheriff (7), Jefferson County sheriff (7), Jessamine County sheriff (7), Knox County sheriff (9), Letcher County sherifff (7), Lincoln County sheriff (7), Marshall County sheriff (7), Pendleton County sheriff (8), Pulaski County sheriff (8), Russell County sheriff (7), and Todd County sheriff (9).

Data on how courts handle domestic violence is not given by judge, court or jurisdiction, but by teh state's 15 area development districts.

It shows that judges in the Lincoln Trail ADD (Meade, Breckinridge, Grayson, Hardin, LaRue, Marion, Nelson and Washington counties) approved only 40 percent of the petitions for EPOs regarding domestic violence, and 31 percent of those for tempotrary interpersonal protective orders.

Judges in the Northern Kentucky ADD (Boone, Kenton, Campbell, Carroll, Gallatin, Owen, Grant and Pendleton counties) had the next lowest approval rates, 63 and 45 percent. The statewide averages, respectively, were 72 and 60 percent.

In divorce and other civil cases where domestic violence was alleged, judges in the Cumberland Valley ADD (Jackson, Rockcastle, Laurel, Clay, Knox, Whitley, Bell and Harlan counties) had the lowest approval rate, 16.9%. Lincoln Trail was second-lowest at 19.8%, just ahead of the Kentucky River ADD (Wolfe, Owsley, Lee, Breathitt, Leslie, Perry, Knott, and Letcher counties), at 19.9%.

In civil cases where other interpersonal violence was alleged, judges in the Gateway ADD (Bath, Montgomery, Menifee, Rowan and Morgan counties) had the lowest approval rate, 9.1%. The next lowest rate, 12 percent, was in the adjoining Fivco ADD (Boyd, Carter, Elliott, Greenup and Lawrence counties). It was 14.9% in the Cumberland Valley ADD.

Generally, judges in the Bluegrass, Purchase and Green River ADDs were the most likely to issue protective orders.

The report was required by a 2022 law sponsored by state Sen. Whitney Westerfield, a Republican from Christian County. "Before this report, domestic violence advocacy groups had used a newspaper clipping service to keep track of domestic violence homicides," the Herald-Leader reports.

Westerfield, chair of the Senate Judiciary Committee, learned of the lack of centralized reporting from Herald-Leader Opinion Editor Linda Blackford. “It’s just unacceptable,” he told her as the bill mved through the legislature. “We can’t make informed public policy decisions without good information.”

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