LOUISVILLE, Ky. – A detailed study tracking the impact of the Affordable Care Act on Kentuckians finds significant gains in both access to health care and the number of people who have insurance.

Susan Zepeda, president and CEO at the Foundation for a Healthy Kentucky, says her organization commissioned a Minnesota-based health policy research institute to track things such as access, cost and quality of care.

One year into the three-year study, Zepeda says the results show more Kentuckians are becoming aware they have a chronic health condition.

"Which you might infer means that more of them are getting access to those screenings, those diagnostic tests, and being told perhaps for the first time that they had a chronic health condition," she states.

The study found the prevalence of chronic disease among Kentucky adults was at just over 29 percent in 2014, up more than 2 percent from 2012 – something expected, in part, because the state expanded Medicaid.

Gabriela Alcalde, the foundation's vice president for policy and programs, says the dramatic drop in the state's uninsured rate – nearly 5 percent from 2012 to 2014 – has had a "very positive" impact.

"So that's the main headline,” she stresses. “Many, many more Kentuckians have access to care and they're using more preventive care, which is also very good."

The study also found visits to the emergency room dropped 5.5 percent in the past year, which Alcalde says can be attributed to increased access to other sources of care.

She says years two and three of the study will dig much deeper into provider and consumer experiences. And, while there have been no big surprises yet, Alcalde says the first-year findings do show how Kentucky's handling of the Affordable Care Act compares to other states.

"Because each state has implemented it in a different way,” she explains. “So it offers a natural experiment that we can really see what different health policy choices can have an impact on health outcomes, health access and the cost of health care."

Kentucky's new governor, Matt Bevin, is in the process of dismantling the state-based health exchange and he's also trying to change how Medicaid is delivered.

Alcalde says because of the lag in data, the impact of those changes will not be part of the foundation's three-year study.





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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.