When lawmakers convene in Frankfort for the 2018 General Assembly session, their debates will be dominated by pension reform and a new state budget.
But the commonwealth also faces a range of important health issues that could come up during the 60-day legislative session that starts Jan. 2. How does the state continue to battle the epidemic of drug addiction? Should marijuana use be legalized and tobacco use be restricted? And can officials find the money to support children in foster care as well as those who depend on Medicaid?
KET’s Kentucky Tonight convened a panel of legislators to discuss those issues. The guests were Sen. Julie Raque Adams (R-Louisville), chair of the Senate Health and Welfare Committee; Rep. Addia Wuchner (R-Burlington), chair of the House Health and Family Services Committee; Rep. Chris Harris (D-Forest Hills); and Rep. Angie Hatton (D-Whitesburg).
The Drug Addiction Crisis
Opioid and heroin addiction continue to ravage all parts of the commonwealth, with more than 1,400 deaths due to a drug overdose counted in 2016.
“It’s effectively making orphans of our children,” says Rep. Angie Hatton. “It’s a law enforcement issue, it’s a social issue but it’s definitely a health issue.”
Lawmakers have discussed how to shift the response to the drug crisis from jailing those with an addiction to providing them more treatment options. But Sen. Julie Raque Adams says the trend lines for incarceration continue to increase, especially among women. She hopes to see creative criminal justice reforms to reverse that trend, get more people into recovery, and save the state millions in prison costs.
Rep. Addia Wuchner is drafting legislation to address the special problems faced by pregnant women who have an addiction. Babies exposed to opioids while in their mothers’ wombs can develop neonatal abstinence syndrome. After delivery those babies must be treated for withdrawal.
Getting pregnant women into treatment not only helps them but can also reduce the medical complications their children will face. Wuchner wants to provide additional services to those mothers to ensure that they don’t return to using drugs.
“Give her the life skills, give her the job training,” says Wuchner. “Job training that will be able to support her family and carry her along that recovery pathway. And that takes time… It’s a long process, an 18-month to two-year process.”
Like so many health care issues, Adams says early interventions to help these mothers and babies can provide a variety of benefits.
“The numbers show that if we can get these pregnant women into treatment and they can deliver a baby under those circumstances, then the state of Kentucky saves a tremendous amount of money,” Adams says. “So it’s not only good for the mom, it’s good for the baby and it’s good for Kentucky.”
Beyond neonatal abstinence syndrome lies another problem. Wuchner says upwards of 90 percent of babies born to mothers with an addiction or a history of intravenous drug use test positive for Hepatitis C. She says that will necessitate even more screening and treatment for those infants.
The Centers for Disease Control and Prevention lists 54 Kentucky counties as being at significant risk for an outbreak of Hepatitis C or HIV because of IV drug abuse. A state law passed in 2015 allows local communities to implement needle-exchange programs as a way to stem the spread of blood-borne diseases among those with an addiction. But of those 54 vulnerable counties, only 21 have needle exchanges, according to a recent Courier-Journal report.
Sen. Chris Harris says he initially opposed the idea of providing free needles to those with an addiction. But he says the success of these programs quickly changed his mind.
“It saves lives [and] it saves money in our budgets,” says Harris. “One case of Hepatitis, having to have organ replacements and the like, you’re looking at hundreds of thousands of dollars per case. When a 20-cent needle can prevent that from happening, that’s a big deal.”
An Addiction to Nicotine
Many Kentucky farmers have moved away from growing tobacco since the end of the federal quota program in 2004, but tobacco use remains alarmingly high in the commonwealth. Almost a quarter of adult Kentuckians and nearly 17 percent of high school students are active smokers.
Tobacco-related health issues costs the state almost $2 billion a year in medical costs, and result in 8,900 deaths annually. Kentucky employers also lose $3 billion a year in productivity costs due to tobacco-related illnesses, according to Adams.
For years, state legislators have tried to limit smoking in public places and increase the tax on cigarettes without much success. The 2018 General Assembly session will see new attempts on both those fronts.
For example, Sen. Steven Meredith (R-Leitchfiled) has prefiled a bill that would increase Kentucky’s 60-cent-a-pack cigarette tax by $1, which could generate as much as $266 million a year in extra revenues for the state. Meredith wants proceeds of that levy to go towards compensating the state for smoking-related health care costs paid by Medicaid, and funding cessation programs in local communities that have public smoking restrictions. A tax reform package prefiled by Rep. Jim Wayne (D-Louisville) would also increase the levies on cigarettes and other tobacco products sold in the state.
“That’s an option that we will have to look at,” Harris. “Our cigarette tax in Kentucky is about a third of the national average. It’s half of what West Virginia’s is.”
With the prospect of ever-tighter state budgets, a higher cigarette tax seems to be the one tax increase that garners bipartisan support in the commonwealth, at least among the lawmakers on the program. In addition to generating revenues for the state, Wuchner says higher tobacco taxes would encourage current smokers to quit and could prevent young people from starting to smoke.
“I’m not a tax person but I see the increase on the cigarette tax not so much as a tax as it’s an increase of the user fee,” Wuchner says.
For more than 25 years lawmakers have tried to enact smoking bans and met fierce resistance from legislators from tobacco-growing communities. In the 2017 session, Sen. Ralph Alvarado (R-Winchester), who is a doctor, proposed a bill to ban tobacco use on school property and at school-sponsored functions. The measure passed the Senate but died in the House.
Although some two dozen communities already have smoking restrictions of some kind, Adams says people still oppose statewide smoking bans. So she is proposing legislation next year that would prevent state smoking laws from preempting any local measures that take a tougher stance on public tobacco use.
“We’ve heard over the last several years it needs to be local control, it needs to be a local decision,” says Adams. “Myself and other members of the General Assembly listened and so I think that this is a creative way for us to say, OK, start [enacting local limits].”
The Democrats on the panel agree that Adams’ approach is a good strategy.
“I personally think it needs to be an individual community decision,” says Hatton. “It’s sort of a personal-freedom issue for a lot of people.”
Expect recreational and medicinal marijuana use to be another hot health-care top in the 2018 legislative session. Around the nation, 29 states have legalized some form of medicinal marijuana; seven states allow recreational use.
“I think the time is coming in Kentucky for medical marijuana,” says Harris. “We’ve got a lot of the states that are around us that have done it… There is some track record in these other states as to how successful that it’s been… and how they’ve been able to manage it.”
Wuchner says she expects to see a range of legislation on medicinal marijuana to be proposed in 2018, including measures to allow its use in end-of-life situations and by military veterans suffering from post-traumatic stress disorder. The Republican says she wants to see more research on the medical efficacy of medicinal marijuana. Democrat Harris says he’s open-minded on the issue but wants to see specific legislation before committing to a position.
Hatton says she believes that medical marijuana could help reduce addiction and overdose deaths from opioids. She also sees economic benefits to laxer marijuana laws, including potential tax revenues and jobs in growing and dispensing marijuana.
Adams says she’s not sure if Kentucky is ready for legalized marijuana, but she says she’s facing increased pressure to hold hearings in the Senate Health and Welfare Committee to explore the possibilities.
“Make no mistake, this is not a simple issue,” says Adams. “There’s very strong feelings on all sides of this issue… and I think that we’ll see those come out.”
Funding for Health and Social Services
Kentucky legislators have two huge tasks ahead of them in the 2018 session: Enacting pension reform and creating a new two-year state budget. (Make that three huge tasks should they also decide to tackle tax reform.) The massive unfunded liabilities in the public employee and teacher retirement programs will overshadow the budget debates and likely force more severe cuts to state spending.
That could put a variety of functions provided by the Cabinet for Health and Family Services (CHFS) at risk, from addiction and mental health treatment to foster care supports and social worker pay.
Adams says she doesn’t want to cut human services, and she hopes that her fellow lawmakers will understand that spending money on things like mental and behavioral health now will save the state money in the long run.
As lawmakers consider changes to the state’s adoption and foster care system, Wuchner advocates restoring payments to relatives who step in to raise the child of a family member who is unable to fulfill their parenting duties. Some 70,000 Kentucky children are living in so-called kinship care. The state used to pay those caregivers a $300 a month stipend, but those payments ended in 2013 because of budget cutbacks. Meanwhile traditional foster parents continue to receive $750 a month.
Even as the state faces tight budget prospects, Harris and Wuchner says it’s important to help kinship caregivers, many of whom are older individuals that may have limited resources even before taking a grandchild, niece or nephew into their homes.
“It’s all about the dollars and cents and the budget, but I think we’ve got to help in that relative care because they’re just struggling,” Wuchner says.
In October, the U.S. Supreme Court refused to hear a case concerning kinship care payments in Kentucky, which in essence means the state must begin paying kinship caregivers the same monthly stipend given to foster-care parents.
Wuchner hopes the state will save the money if federal regulators approve the Bevin Administration’s Medicaid waiver application. That overhaul would add work requirements for some Medicaid enrollees as well as small premiums and copays. Wuchner says certain enrollees would also get job training that could lead to better paying work and employer-provided health coverage.
Republicans contend the changes are necessary, otherwise the state can’t afford to continue the expanded Medicaid coverage that enrolled thousands of low-income Kentucky families. Harris, Hatton, and other Democrats say the Medicaid expansion has benefited poor people who previously had no health insurance and local hospitals that have experienced a significant drop in their indigent care costs.
“So it’s like it’s punitive in nature towards people who really need the coverage,” says Hatton. “We’ve gone from 20 percent uninsured in eastern Kentucky down to 5 percent, and that’s amazing.”