FRANKFORT, Ky. - A "real mess." That's how one health-care advocate describes Kentucky's transition to a single system to determine eligibility for health insurance and other social services.

People who depend on kynect – the state health-insurance exchange that was hailed as a model for the nation – have been especially concerned about the transition, although Gov. Matt Bevin's office said his plans to dismantle kynect have nothing to do with the current technical problems.

Emily Beauregard, executive director of Kentucky Voices for Health, said she has heard numerous reports of people being "mysteriously dis-enrolled" from Medicaid, errors on applications and long waits for help.

"The wait time for the people who stay on the line is over two hours, but 6,000 to 7,000 calls a day go unanswered," said Beauregard. "That's a lot of people who can't get assistance."

She cited glitches in the system and not enough workers to handle the job, and said assistance from the folks known as "kynectors" is not always possible.

Cabinet for Health and Family Services spokesman Doug Hogan acknowledged the difficulties and said the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

In the meantime, Pikeville resident and Medicaid recipient Connie Holt, who has many chronic health conditions, said her efforts to change her insurance provider became a daily nightmare.

"I was in tears by the end of the day," said Holt. "I would make calls until my battery went dead on my phone, and I'd have to plug it in to charge. Back and forth, all day long."

Cara Stewart, who was Holt's kynector in the process, said it took her over two weeks of nearly daily efforts to get the change made for Holt – which she added would have taken "five minutes last fall," under kynect.

Transitioning from kynect to a federal insurance exchange continues to be controversial.

State representatives in the Democrat-controlled House are expected to vote soon on legislation (HB 5 and HB 6) that would keep kynect and protect Medicaid expansion. Supporters say these have led to a sharp decline in uninsured rates, fewer emergency room visits and more preventive care.

According to Beauregard, 'yes' votes from the House would make a strong statement.

"We know from a recent Kaiser Family Foundation poll that 72 percent of Kentuckians want to keep Medicaid expansion without any changes," she said. "And twice as many Kentuckians want to keep kynect."

However, Gov. Bevin and many Republican lawmakers say the state health insurance exchange is too expensive, and think the way Medicaid is delivered to 1.3 million Kentuckians should be restructured.



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Toughing it out during spring allergy season is not in your best interest if you want to avoid asthma later in life.

New Mexico has plenty of grass and weed pollens carried by the wind which contribute to itchy, watery eyes, a stuffy nose and sneezing fits this time of year.

Dr. Osman Dokmeci, associate professor of internal medicine at the University of New Mexico, suggested for those who suffer acutely, seek an allergy test and possibly medication to prevent asthma from taking hold.

"One out of 10 has asthma in America," Dokmeci pointed out. "Having seasonal allergies increases your chance of developing asthma at least fivefold."

He recommended treating allergies early and as aggressively as possible. May is "Asthma Awareness Month," which aims to bring attention to the health issue and highlight improvements in care and quality of life. Nationwide, asthma affects more than 25 million Americans, including 4 million children, and disproportionately affects certain racial and ethnic groups.

Allergies do not "cause" asthma but people who have allergies, or have family members who have allergies, are more likely to get asthma than those who do not. Research shows allergy season is starting earlier and lasting longer. A 2022 study from the University of Michigan found pollen count could increase by 200% by the end of the century due to climate change, which is why Dokmeci stressed it is important not to ignore the problem.

"There's no treatment that actually makes your asthma not happen," Dokmeci explained. "But once you develop asthma, there are good treatment options."

The estimated economic impact of asthma is more than $80 billion per year from direct and indirect costs, such as missed school and workdays.

Recent research shows approximately half of people who die by suicide had contact with a health care professional within the month prior to their death.

However, a recent study shows only 8% of hospitals are currently implementing all four recommended suicide prevention practices: safety planning, warm handoffs to outpatient care, patient follow-up and lethal means counseling.

Melissa Tolstyka, director of Behavioral Health Services for Trinity Health Ann Arbor, said a seamless transition from inpatient to outpatient care is critical. At Ann Arbor, she saw a 46% increase in compliance with comprehensive suicide risk assessments and patients discharged on the suicide care pathway now receive a safety plan, which she sees as progress.

"We continue to see a need for really robust programming," Tolstyka explained. "Not just within the behavioral health world, but in the medical world as well. Our organization really wanted to focus on bringing the behavioral health and the medical services together to enhance our safer suicide care practices for our patients."

The initiative is being piloted across various units at Trinity Hospitals in Ann Arbor and Grand Rapids including the emergency department, psychiatric medical and inpatient nursing units. If you or anyone you know is struggling or in crisis, help is available 24 hours a day, seven days a week, by calling or texting 988, the Suicide and Crisis Lifeline.

Casie Sultana, clinical nurse leader for Trinity Health Grand Rapids, prioritizes patient well-being, emphasizing support and improvement over solely managing risks within the facility.

"We want to be someplace that people feel welcome to come to who are dealing with suicide," Sultana emphasized. "You feel so alone. It's a very lonely journey and we want people to come seek help and feel welcomed when they do that."

Susan Burchardt, clinical services manager at Trinity Grand Rapids, advised other hospitals considering a similar program to learn from organizations already using it.

Support for this reporting was provided by The Pew Charitable Trusts.


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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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