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Sunday, September 17, 2023

Op-ed looks at ways to address loneliness, which is linked to a number of health conditions; Ky. is above average for loneliness

Kentucky ranks in the top 20 states for loneliness, which can involve far more than feelings of sadness from being alone. Research shows it is linked to strokes, heart disease, dementia, inflammation and suicide.

"It breaks the heart literally as well as figuratively," opinion columnist Nicholas Kristof writes for the New York Times as part of a series titled "How America Heals," aimed at finding ways to fix this problem. 

The physical and societal harms that come from loneliness are so bad that America's top public-health official, Surgeon General Vivek H. Murthy, issued a rare advisory with a framework to rebuild social connection and community in the U.S. in May.

Graph from surgeon general's advisory,
"Our Epidemic of Loneliness and Isolation"
 
Loneliness is as deadly as smoking 15 cigarettes a day and more lethal than consuming six alcoholic drinks a day, according to Murthy. It is also more dangerous than physical inactivity, obesity and air pollution, he says. 

Research also shows America has been growing lonelier. A majority of adults (58 %) report experiencing loneliness, according to a Morning Consult survey commissioned by The Cigna Group, a health-insurance company.

An Aging In Place study found that Kentucky tied with Arkansas for loneliness at 18th among states, with scores of 5.16 on a 10-point scale. Maine was first at 7.6, and Utah was best off, at 0.72. The study noted that more than half of Utahns identify as Mormons, which "may contribute to the low numbers of divorce and single-person households."

The study looked at a range of factors, including the percentage of single-person households, number of people widowed, number of people divorced, searches for dating apps per 10,000 people and searches for friendship apps per 10,000 people, to determine which states struggle the most with loneliness.

Kristof writes that there are ways to build connections that bind us together and writes about some of those approaches taken by the United Kingdom, which he says "is the pioneer of these efforts, having established the post of minister for loneliness in 2018. Britain oversees public-private partnerships that collectively knit millions of people together with programs like nature walks, songwriting workshops and community litter pickups." And, he adds, other countries have followed suit.  

"That’s because if the researchers are correct, social isolation probably kills far more people in the West each year than terrorists and murderers, and it costs the public enormous sums in unnecessary health costs," Kristof writes. "Countermeasures can make a huge difference: One review of 148 studies concluded that social connections increase the odds of an individual’s surviving over roughly the next seven years by about 50 percent." 

Kristof says he writes from troubles he's witnessed: "More than one-quarter of the children who rode the No. 6 school bus with me in Yamhill, Oregon, have died from drugs, alcohol, suicide and other so-called deaths of despair. These pathologies are linked to social isolation." 

However, he notes that despite the economic devastation of during the Great Depression, mortality then didn’t rise but actually fell." He attributes this to the "strength of community institutions -- like churches, men's and women's clubs and extended families -- that existed during that time." 

Ninety-odd years later, "Those community institutions have frayed," he writes. "Now we’re on our own, and perhaps that’s why so many are also dying alone." 

Kristof says he recognizes that it's not easy to rebuild such networks, but says we have to try, and offers some suggestions. 

"The steps to tackle loneliness aren’t grand, high-tech or expensive. In fact, one of the strategies is simply to get people back into old-fashioned patterns like eating meals together, holding parties and volunteering to help one another out," he writes.

He notes that the U.K. ministry has spent "some $100 million" to address loneliness since 2018, often to support local initiatives. One of those is a local, weekly family-style luncheon for women and children, many of them immigrants who struggle with English. 

He says decline of religious attendance has left a gap in community building, but "church buildings can still provide a physical architecture for connections, even if the faith architecture has eroded." 

He also points to several community-wide events to combat loneliness, including an event held for King Charles's coronation in May called “The Big Help-Out” to encourage people to come together and volunteer, and 6 million people, almost a tenth of the nation's population, did so. "The response was so impressive that this may become an annual event," he writes.

Why did loneliness increase? Kristof says the trends toward larger homes and longer working hours has left less time to share meals, and he notes studies that show social media has led to people being more lonely. Pets and talking robots have been suggested as solutions, he writes, but "It seems that there’s something to be said for friends who are living, breathing human beings." 

In his advisory, Surgeon General Murthy offered a strategy to address loneliness that begins with building up infrastructure that enables social connection: physical infrastructure such as parks and libraries, and social infrastructure to weave together volunteers or enthusiasts with similar interests.

Britain can serve as a model for this, Kristof writes. He points to a town that has has trained more than 1,100 volunteers to be “community connectors" who engage people and encourage them to join events or participate in programs. He also points to the idea of a "chatty bench" adopted in the U.K., Sweden and Australia, a bench with a sign encouraging strangers to talk to each other. 

"Solutions to loneliness are like that — little nudges to encourage us to mingle the way we evolved to," Kristof writes, suggesting that government do more: "President Biden, how about creating a senior government post analogous to a minister for loneliness? And mayors and governors, how about some chatty benches in American parks, along with volunteers deputized to bring us out for nature walks and sing-alongs?"

One case among thousands, highlighted at UK event, helps illustrate why Kentucky needed a comprehensive cancer center

Cancer survivor and medical student Anna Cox gets applause
at Friday's announcement; at right is Dr. Mark Evers, director
of the Markey Cancer Center. (University of Kentucky photo)
By Sarah Ladd
Kentucky Lantern

Anna Cox had just graduated from the University of Kentucky when she was diagnosed with blood cancer in 2018. She first sought emergency care for a “wrenching abdominal pain.” It turned out to be related to stage four diffuse large B-cell lymphoma, a type of non-Hodgkin lymphoma.

Cox was treated at the university’s Markey Cancer Center, which made history Friday by announcing it is recognized by the National Cancer Institute as a “comprehensive” cancer center — the only one in Kentucky.

“I had never been sick before, and I did not even have a primary-care doctor,” Cox said Friday at the Gatton Student Center, where she joined politicians and university staff to to announce the honor. “With a Stage 4 diagnosis, naturally I was scared of what was to come. But my team at Markey was with me every step of the way.”

Markey is now one of 56 comprehensive cancer centers in the United States. The designation goes to institutions that conduct in-depth research, among other things.

Because of the “compassionate” care she received there, the now cancer-free Cox returned to UK to pursue a medical degree.

“What started with time as a cancer patient led me to innovative cancer research and into medical school as a future physician — all at one institution,” Cox said. “This is what being a comprehensive cancer center is all about.”

State Senate President Robert Stivers, a Republican from Manchester, praised the “added value” the state will enjoy with the new designation.

“This is not a football school; this is not a basketball school,” Stivers said in Lexington. “This is a school that will be known as a center of excellence for cancer research and giving hope for a cure to those who fight this with their family and friends.”

Also on hand for the announcement were UK President Eli Capilouto, Democratic Gov. Andy Beshear, U.S. Rep. Andy Barr, R-Lexington, and others. In a pre-recorded video, U.S. Sen. Mitch McConnell said the honor paves the way “for even more groundbreaking research in the fight against cancer and ensuring that Kentucky’s communities will receive the gold standard of cancer care.”

In 2021, more than 10,000 Kentuckians died with cancer, according to the Centers for Disease Control and Prevention, making it one of the more deadly states for cancer patients. Almost all of Markey’s patients come from Kentucky, UK said in a press release.

Markey patients now have “access to new drugs, treatment options and clinical trials offered only at NCI-designated centers,” UK said in a statement. 

Barr said, “It means that we can attract the best clinicians, the best researchers, more research dollars, better clinical trials. And that means better outcomes. And, boy, do we need it in the Commonwealth of Kentucky.”

Friday, September 15, 2023

UK cancer center gets top U.S. designation, shared by 55 others

UK wasted no time promoting the new designation Friday on its
Cornerstone display on Limestone Street. (Photo by Al Cross)
Kentucky Health News

The University of Kentucky's cancer center has received the highest designation from the National Cancer Institute, making it the first such center in Kentucky, it announced Friday. The United States has 56.

In 2013, the Markey Cancer Center received its initial NCI designation, held by 72 centers in the nation. It worked for a decade to get the higher designation, based on research, treatment, diagnosis and prevention.

“It’s really the gold standard of clinical care, research and community outreach,” said Dr. Mark Evers, who has been director of the center since 2009, when the university started trying for NCI designation.

UK President Eli Capilouto said, “To truly be the University for Kentucky, we raised the stakes and decided that UK will continue to be a leader in cancer research by becoming a comprehensive cancer center.”

The closest comprehensive cancer center "is nearly 200 miles from Lexington," a UK press release noted. That one is at Vanderbilt University in Nashville, which competes with UK for patients living in Western Kentucky. Indiana University has a comprehensive cancer center in Indianapolis.

Kentucky has the nation's third highest rate of death from cancer, behind West Virginia and Mississippi, and cancer is the state's second most common cause of death, next to heart disease. 

"The elevation to an NCI-designated comprehensive cancer center will further enhance Markey's ability to attract top-tier researchers and clinicians, secure additional research funding, collaborate with national and international partners, and give patients access to leading-edge treatments and clinical trials – resulting in better patient care and health outcomes for Kentuckians," the release said. "Numerous studies show that patients treated at NCI-Comprehensive Cancer Centers have better survival and recovery rates."

In addition to the comprehensive designation, NCI awarded the center $13.5 million through a five-year renewal of its grant for research programs, shared equipment and resources.

Since 2013, more than 100 cancer researchers have been recruited to UK and external funding to Markey researchers has more than doubled, the release said. Markey’s outpatient visits have increased by 69% and the number of new patients has gone up 75%.

The center's growth prompted UK to start work on a new treatment center and advanced ambulatory complex that will bring Markey's outpatient services under one roof. It is expected to open in 2027.

Thursday, September 14, 2023

Most people have end-of-life wishes, but don't talk about it; planning for death is less likely in rural areas, study finds

St. David's Foundation graph; click on it to enlarge.
As America ages, more families face end-of-life decisions, and rural Americans are less likely to have their wishes known or followed by family members, reports Liz Carey of The Daily Yonder. "A new study found that while most people have end-of-life wishes, only a little over a third of them actually get them fulfilled. That is even more true with rural residents, researchers said."

Researchers from St. David's Foundation in Texas found that when it comes to end-of-life care, most Texans want to die at home (76%) and not be a burden to their families (77%). "But only one in three people surveyed said their loved one's wishes were honored," Carey writes. "Of those who are least likely to have their end-of-life wishes followed are rural residents, the study found. . . . Only 37% of the survey respondents said their loved ones died at home. Close to half of them (47%) said their loved one faced challenges related to their care – from problems with insurance coverage to facing cultural or language barriers."

Honoring a person's wishes begins with knowing what they are. Andrew Levack, senior program officer with St. David's Foundation, told Carey: "One of the interesting things the study found was how few conversations respondents had with their doctors around plans for end of life. I think people have an idea of what they would like, but it takes some active planning and advocacy to make that happen."

Study researchers noted a common thread of disconnection across the state -- people have end-of-life care desires, but don't voice them. "Most Texans, even older adults, are unprepared for decisions about end-of-life care. The vast majority believe it is important to have their wishes in writing, yet over half have not done so. Similarly, many say they would like to discuss end-of-life planning with their health care provider if they were faced with a serious illness, yet only 17% have had a provider initiate a conversation about it."

Geographical isolation and a lack of health care access make rural populations more likely to not have end-of-life plans or discussions. Dr. Kate Tindell, medical director for Austin Palliative Care and Hospice, told Carey: "People have really disjointed health care now. We've sort of lost that sense that there is a captain of the medical ship who is aware of all the moving parts and is giving the patient that guidance. I think that really causes people to not have the kind of relationship that would allow them to have that kind of conversation (about end-of-life wishes) the way they would if they had seen the same provider every single time for 10 years."

Why the CDC recomends new Covid-19 boosters for everyone

Photo illustration by Waldo Sweigers, Bloomberg Creative Photos
By Arthur Allen
KFF Health News

Everyone over the age of 6 months should get the latest Covid-19 booster shot, a federal expert panel recommended Tuesday after hearing an estimate that universal vaccination could prevent 100,000 more hospitalizations each year than if only the elderly were vaccinated.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 for the motion after months of debate about whether to limit its recommendation to high-risk groups. A day earlier, the FDA approved the new booster, stating it was safe and effective at protecting against the covid variants currently circulating in the U.S.

After the last booster was released, in 2022, only 17% of the U.S. population got it — compared with the roughly half of the nation who got the first booster after it became available in fall 2021. Broader uptake was hurt by pandemic weariness and evidence the shots don’t always prevent Covid infections. But those who did get the shot were far less likely to get very sick or die, according to data presented at Tuesday’s meeting.

The virus sometimes causes severe illness even in those without underlying conditions, causing more deaths in children than other vaccine-preventable diseases, as chickenpox did before vaccines against those pathogens were universally recommended.

The number of hospitalized patients with covid has ticked up modestly in recent weeks, CDC data shows, and infectious disease experts anticipate a surge in the late fall and winter.

The shots are made by Moderna and by Pfizer and its German partner, BioNTech, which have decided to charge up to $130 a shot. They have launched national marketing campaigns to encourage vaccination. The advisory committee deferred a decision on a third booster, produced by Novavax, because the FDA hasn’t yet approved it. Here’s what to know:

Who should get the covid booster? The CDC advises that everyone over 6 months old should, for the broader benefit of all. Those at highest risk of serious disease include babies and toddlers, the elderly, pregnant women, and people with chronic health conditions including obesity. The risks are lower — though not zero — for everyone else. The vaccines, we’ve learned, tend to prevent infection in most people for only a few months. But they do a good job of preventing hospitalization and death, and by at least diminishing infections they may slow spread of the disease to the vulnerable, whose immune systems may be too weak to generate a good response to the vaccine.

Pablo Sánchez, an Ohio State pediatrics professor who was the lone dissenter on the CDC panel, said he was worried the boosters hadn’t been tested enough, especially in kids. The vaccine strain in the new boosters was approved only in June, so nearly all the tests were done in mice or monkeys. However, nearly identical vaccines have been given safely to billions of people worldwide.

When should you get it? The vaccine makers say they’ll begin rolling out the vaccine this week. If you’re in a high-risk group and haven’t been vaccinated or been sick with covid in the past two months, you could get it right away, says John Moore, an immunology expert at Weill Cornell Medical College. If you plan to travel this holiday season, as he does, Moore said, it would make sense to push your shot to late October or early November, to maximize the period in which protection induced by the vaccine is still high.

Who will pay for it? When the ACIP recommends a vaccine for children, the government is legally obligated to guarantee kids free coverage, and the same holds for commercial insurance coverage of adult vaccines. For the 25 to 30 million uninsured adults, the federal government created the Bridge Access Program. It will pay for rural and community health centers, as well as Walgreens, CVS, and some independent pharmacies, to provide covid shots for free. Manufacturers have agreed to donate some of the doses, CDC officials said.

Will this new booster work against the current variants of Covid-19? It should. More than 90% of currently circulating strains are closely related to the variant selected for the booster earlier this year, and studies showed the vaccines produced ample antibodies against most of them. The shots also appeared to produce a good immune response against a divergent strain that initially worried people, called BA.2.86. That strain represents fewer than 1% of cases currently. Moore calls it a “nothingburger.”

Why are some doctors not gung-ho about the booster? Experience with the Covid vaccines has shown that their protection against hospitalization and death lasts longer than their protection against illness, which wanes relatively quickly, and this has created widespread skepticism. Most people in the U.S. have been ill with covid and most have been vaccinated at least once, which together are generally enough to prevent grave illness, if not infection — in most people. Many doctors think the focus should be on vaccinating those truly at risk.

With new Covid boosters, plus flu and RSV vaccines, how many shots should I expect to get this fall? People tend to get sick in the late fall because they’re inside more and may be traveling and gathering in large family groups. This fall, for the first time, there’s a vaccine — for older adults — against respiratory syncytial virus. Kathryn Edwards, a 75-year-old Vanderbilt University pediatrician, plans to get all three shots but “probably won’t get them all together,” she said. Covid “can have a punch” and some of the RSV vaccines and the flu shot that’s recommended for people 65 and older also can cause sore arms and, sometimes, fever or other symptoms. A hint emerged from data earlier this year that people who got flu and covid shots together might be at slightly higher risk of stroke. That linkage seems to have faded after further study, but it still might be safer not to get them together.

Pfizer and Moderna are both testing combination vaccines, with the first flu-covid shot to be available as early as next year.

Has this booster version been used elsewhere in the world? No, but Pfizer’s shot has been approved in the European Union, Japan, and South Korea, and Moderna has won approval in Japan and Canada. Rollouts will start in the U.S. and other countries this week.

Unlike in earlier periods of the pandemic, mandates for the booster are unlikely. But “it’s important for people to have access to the vaccine if they want it,” said panel member Beth Bell, a professor of public health at the University of Washington.

“Having said that, it’s clear the risk is not equal, and the messaging needs to clarify that a lot of older people and people with underlying conditions are dying, and they really need to get a booster,” she said.

ACIP member Sarah Long, a pediatrician at Children’s Hospital of Philadelphia, voted for a universal recommendation but said she worried it was not enough. “I think we’ll recommend it and nobody will get it,” she said. “The people who need it most won’t get it.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation.

Wednesday, September 13, 2023

How rural hospitals are fighting Medicare Advantage -- for both blogs



https://ift.tt/lWsntDj




Nona Tepper reports for Modern Healthcare
How rural hospitals are fighting Medicare Advantage

Last month, St. Charles Health System threatened to cut ties with all Medicare Advantage plans next year, a move that would leave an estimated 26,000 local beneficiaries without access to a hospital less than 100 miles away.

“The reality of Medicare Advantage in central Oregon is that it just hasn’t lived up to the promise," St. Charles Health System CEO Dr. Steve Gordon wrote in a news release at the time. "A program intended to promote seamless and higher quality care has instead become a fragmented patchwork of administrative delays, denials and frustrations," he said. The Bend-based nonprofit company declined to make an executive available for an interview.

Health systems nationwide appear to share Gordon's consternation, especially those similarly located in rural areas. Rural healthcare providers tend to be disproportionately affected by factors such as reimbursement cuts or denied and delayed payments from Medicare Advantage plans because Medicare enrollees make up most of their patient populations. Cutting off Medicare Advantage plans, or at least declaring that to be a possibility, is a response to the growing market power these carriers have, especially over rural providers.

"There's a lot of confusion and concern in the community right now," said Jeremy Vandehei, Oregon market president at PacificSource, a nonprofit insurance company. About 15,000 PacificSource Medicare Advantage members are St. Charles patients, he said.
Medicare Advantage growth

Although Medicare enrollees make up a disproportionate share of patient volume at St. Charles, rural areas generally are less successful for Medicare Advantage plans compared to urban and suburban regions.

Narrow provider networks, for example, spur twice as many rural Medicare Advantage enrollees to switch to the fee-for-service program than urban beneficiaries, according to a study published in Health Affairs in 2021. Less local competition also translates into higher premiums, the consulting company Milliman reported in April.

“Rural providers are feeling the pain points amplify and get larger as Medicare Advantage enrollment gets bigger,” said Molly Smith, group vice president for public policy at the American Hospital Association.

As competition intensifies among Medicare Advantage insurers, rural counties offer them one of the few remaining opportunities to boost business. Rural Medicare Advantage enrollment is growing faster than overall enrollment: Since 2010, the share of rural beneficiaries who choose private plans over the traditional program has more than quadrupled, to 40% from 11%, according to KFF survey results published this month.

Regulatory changes have contributed to making rural markets more welcoming to Medicare Advantage. The Centers for Medicare and Medicaid Services relaxed network adequacy standards for Medicare Advantage plans operating in non-metropolitan areas in 2020. The agency also offered additional flexibility in network regulations to Medicare Advantage plans that contract with telehealth providers or operate in states with certificate of need laws. CMS has approved 92% of requests for exemptions from network rules, according to the most recent federal data.
Tough negotiations

St. Charles’ decision to exit Medicare Advantage networks was dramatic and not without precedent. Brookings Health System, a nonprofit municipal provider in South Dakota, took the same action last month. Brookings declined to comment

Ozarks Community Hospital considered shunning Medicare Advantage plans but could not afford it, said Scott Taylor, administrator of the Gravette, Arkansas-based critical access hospital. Medicare Advantage covers more inpatient stays at the for-profit facility than any other payer, he said.

Despite dissatisfaction with Medicare Advantage, Ozarks concluded it had no choice but to stay the course, Taylor said. “We don't ever know when, or how much, or why our payments are delayed,” he said. “But at this point, it’s so bad that we're just thankful we get any money, which is not a great place to be in when you’re trying to keep the doors open.”

Hospitals are asking for reimbursement increases to cover rising labor and supply costs and looming Medicare payment reductions. Insurers, too, are reckoning with challenges such as Medicare Advantage rate cuts, stricter federal audits and escalating utilization.

Among the 58 publicly known contract disputes between insurers and providers this year, 35—more than half—involved Medicare Advantage carriers, according to data compiled by FTI Consulting. Last year, 29 of 51 were related to the privatized Medicare program.

Most conflicts center on how health insurance companies do business more than on reimbursements, said FTI Consulting Managing Director Adam Broder.

“It's like, ‘What's the point of fighting about rates if we can't even get paid?’” Broder said. “They make money on the commercial contracts. The margins are just so much smaller from Medicaid or Medicare, and if they can't get paid on time or properly or in the full amount, then that's going to lead to a dispute.”

At Aspirus Health, some Medicare Advantage insurers deny as many as 35% of claims, said Matthew Heywood, CEO of the Wausau, Wisconsin-based nonprofit health system. In response, the 17-hospital chain is renegotiating contracts to include provisions regarding prior authorizations and claims processing times, he said.

Aspirus has reached out to state hospital groups to gauge interest in suing insurers over claims reviews and denials, Heywood said. Medicare Advantage insurers are not threatened by single-system lawsuits because the insurance market lacks competition, he said.

“How can we start working with some associations to figure out a joint mechanism for all our smaller members to have a voice that's a little stronger than having to go one-off in the court system?” Heywood said. “It's starting to percolate.”
Cascading consequences

Two weeks after St. Charles Health System announced it wouldn't accept Medicare Advantage next year, the provider restarted negotiations with insurers, Gordon said. Open enrollment begins Oct. 15, but the health system has not settled on what Medicare Advantage networks it will join, if any, he said.

Decisions like these can have effects throughout the healthcare system.

For instance, the absence of St. Charles from local Medicare Advantage networks would make insurers out of compliance with network adequacy rules, Vandehei said.

And providers such as New York-based Summit Health are worried about how splits between rural hospitals and Medicare Advantage insurers would affect shared-risk contracts, said Justin Sivill, chief operating officer for VillageMD’s Summit Health practice in Oregon, which serves Bend and other nearby areas. Summit Health, a Walgreens property, also has a hospitalist team in place at St Charles Health System.

“What we're more afraid of is if they end up using this as a negotiating platform and if they end up negotiating better rates,” Sivill said. “We'll just have to manage the population better.”

The situation at St. Charles demonstrates a need for more lenient network adequacy standards, said Gary Jacobs, executive director of Chicago-based VillageMD’s center for government relations and public policy.

Medicare Advantage insurers should not have to construct networks, and hospitals that accept fee-for-service Medicare should be required to accept Medicare Advantage when plans pay full Medicare rates, Jacobs said. “Allowing a hospital to say no to Medicare Advantage can be really problematic as we advance down the road towards value in healthcare,” he said.

Sunday, September 10, 2023

As Kentucky's near-total abortion ban largely eliminates the procedure in the state, Kentuckians go to other states for it

From January to July of this year, the Kentucky Cabinet for Health and Family Services received reports of 13 abortions in the state, compared to 2,591 in the same time frame in 2021, showing the impact of state laws that were invoked when the U.S. Supreme Court nullified the right to abortion in late June 2022, Alex Acquisto reports in an in-depth article for the Lexington Herald-Leader

Acquisto writes, "The marked cliff is a direct result of Kentucky’s trigger law and six-week ban," which legislators passed in hope of such a ruling. "The trigger law bans all abortions except when a pregnant person’s life is immediately threatened, and the six-week ban, or fetal-heartbeat law, outlaws abortions after fetal cardiac activity develops ... usually around six weeks gestation."

The trend is mirrored in more than a dozen states that have enacted similar policies since the decision in Dobbs v. Jackson Women's Health Organization, according to estimates from the Guttmacher Institute, a policy research center that supports abortion rights. However, "In states that have preserved access, like Illinois, demand for the medical procedure has ballooned," Acquisto writes. 

"From January to June of this year, the number of abortions provided in Illinois grew by an estimated 69% (from 26,000 to roughly 45,000) compared with 2020, according to Guttmacher’s report. Across the board, states without abortion bans saw similar increases. Abortions in Virginia increased by 60%."

Southern Illinois has the closest abortion access to Western Kentucky; the closest to Eastern Kentucky is in Bristol, Virginia.

Acquisto notes that these estimates are  based on abortions reported by providers working in brick-and-mortar clinics and doctor’s offices, so "The true figures are likely even higher, since an estimated increase in abortion medication received by mail is not factored" into the estimates. 

The Guttmacher Institute report did not include numbers from Kentucky. Acquisto got them through an open records request. She writes that the health cabinet is expected to publish its annual abortion report for 2022 this month; state law requires it to be published by Sept. 30 of each year.

Acquisto writes that before the state's near-total abortion ban, "in a given month in Kentucky, between 300 and 400 abortions were provided, state data from recent years shows. . . . Most of the 13 were medication abortions, and most occurred in the second trimester, the latest being 21 weeks."

She adds that the cabinet did not release the ages of the individuals who received abortions in Kentucky so far this year, stating that doing so could create an "unwarranted invasion of personal privacy" because so few abortions were reported. Historically, this information has been public. 

Acquisto reports that piecemeal data provides some insight into how many Kentuckians are traveling out of state for this type of medical care. 

"Before Indiana’s near-total abortion became law in August, state data showed 340 Kentuckians had traveled to the Hoosier state for abortions between January and March, representing roughly 90% of all abortions provided to non-residents," she writes. " In 2022, a total of 950 Kentuckians got abortions in Indiana, WFPL reported in June." 

That shows many people will continue to seek such care despite state bans, Tamarra Wieder, Kentucky state director of Planned Parenthood Alliance Advocates, told Acquisto.

“Kentuckians didn’t stop needing abortions, they’ve just been forced to go elsewhere,” Wieder said. “Those who had the means and the ability to leave the state are leaving the state for that type of care.”

Organizations that help women travel across state lines for reproductive health care say the demand for their help is not letting up, Acquisto reports: "Kentucky Health Justice Network, which offers assistance to people who need help paying for their abortion, fielded more than 500 calls from January to July of this year (421 received donations from KHJN to pay for their abortions)." 

Savannah Trebuna, co-director of KHJN’s abortion support fund, told Acquisto that before August, when Indiana banned abortion, 44% of people who the network's hotline traveled to Indiana for abortions, and since then, KHJN has sent nearly 30 callers to Illinois.

Acquisto also notes the challenges Kentucky women face when they need a medically necessary abortion but their life is not immediately threatened, a situation that current law doesn't allow a doctor to address. 

Trebuna told Acquisto, “There have been cases where we’ve had callers who would have died had they continued their pregnancy, but because they weren’t actively dying in front of a doctor, they were still referred out of state.”