FRANKFORT, Ky. - More than nine out of 10 Kentuckians now have health insurance, but supporters of health-care reform in the Bluegrass State fear a murky future as Republican Matt Bevin prepares to take office as governor on Dec. 8.

Bevin has said he wants to shut down the state's health-benefits exchange, kynect, and transition to the federal exchange. He also wants to roll back Medicaid expansion, which has added more than 400,000 low-income Kentuckians to that program.

To Sheila Schuster with the Action Advocacy Network, rolling back Medicaid "makes absolutely no sense."

"What do you say to people, 'You're not worth getting healthy, you're not worth taking care of?' We had such a good deal, but we're going to say no to it? It makes absolutely no sense," she said, "financially, economically, in terms of business, in terms of the growth of our state, in terms of the health of our state."

Bevin said his intent is not to cut people off but to customize Medicaid to Kentucky through a waiver - known as a "1115 Medicaid demonstration waiver" - of federal rules on eligibility and coverage.

Bevin has pointed to Indiana's model as an example of the direction he wants Kentucky to head. Medicaid recipients there pay either premiums or co-pays, sometimes both. Ashley Spalding, research and policy associate for the Kentucky Center for Economic Policy, said that would tamp down access to health care.

"Research shows that even when premiums and co-payments are seemingly modest," she said, "low-income people are less likely to enroll, and they're less likely to seek needed care."

Gov.-elect Bevin said he isn't looking to make draconian moves. However, Spalding noted that tens of thousands of Kentuckians have received cholesterol screenings, mammograms and other types of preventive care since obtaining insurance through Medicaid expansion. She warned that rolling back expansion could slow down that trend.

"We could see fewer people accessing these preventive-care services," she said, "which, in the long term, we expect to increase not only the health of individuals but to increase the health of our state."


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Oregonians who are ready to leave the hospital but still require care do not have enough places to go, affecting providers and patients at all levels.

The average hospital stay has increased to nearly five days, according to the Hospital Association of Oregon. With nowhere to send discharged patients, hospitals can end up boarding them, which hurts hospitals financially and means fewer beds are available for people who need them.

Sen. Deb Patterson, D-Salem, was part of a task force which released 10 recommendations to address the problem. She said a top priority is presumptive eligibility for Medicaid, so people who likely qualify do not have to wait for their applications to be processed in order to receive care, which would also benefit providers.

"Long-term care facilities need to be assured that the patients they're accepting, they already have their insurance in place," Patterson explained.

Increased reimbursement rates for adult foster homes are high on the list for the task force, as well as continued funding for guardians. Guardians are court-appointed positions who make decisions for adults found incapable of caring for themselves because of dementia or other health problems.

The task force, which included representatives from hospitals, nursing homes and union leaders, said expanding medical respite is also critical. The programs provide short-term residential care for people experiencing homelessness who do not need a hospital to recover from an illness or injury.

Patterson stressed not having access to places to heal can be deadly.

"I would really advocate for funding for medical respite because we do not want to see people dying on the streets," Patterson emphasized.

Another issue contributing to the backlog of patients is staffing shortages in Oregon's skilled nursing and long-term care facilities. Patterson noted the state is collaborating with Future Ready Oregon to grow the health care workforce, including certified nursing assistants. She added another bill is in the works for spring, focusing on entry-level positions in long-term care.


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January's cold temperatures in Missouri and across the nation can pose risks for those with heart conditions.

The American Heart Association has tips on staying heart-healthy in winter - including dressing warmly to reduce strain on your heart, and avoiding overexertion during activities like shoveling snow.

St. Louis Physician, Dr. Ravi Johar, is a board member of the American Heart Association. He said snow shoveling is a leading cause of winter heart problems, especially for men in their 50s and 60s.

He stressed that cold weather constricts blood vessels, increasing the heart's demand for more blood during exertion.

"So you have a combination of the body needing more blood to the heart and getting less flow through it because of the cold weather," said Johar, "and that unfortunately can lead to a heart attack - and it's one of the most common times that you do see a heart attacks occurring, is at that time of the year."

Other winter tips from the American Heart Association include eating balanced meals with fruits, vegetables, lean proteins, and whole grains - and limiting alcohol because it can make you feel warmer than you are, raising the risk of hypothermia.

While it may be very comforting to enjoy a hot cup of cocoa or apple cider in the winter, heart health experts warn these drinks are often loaded with sugar - which can be dangerous for the heart if you drink too much.

Dr. Johar added that exercising in winter can be very beneficial.

"Exercise at any time of the year will increase your immunity," said Johar. "So during cold and flu season, having a little bit better immunity is always beneficial. You do need to make sure you have enough fluids, you need to stay hydrated even though you don't feel quite as thirsty cause you're not sweating as much, it's real important to make sure you stay hydrated."

The American Heart Association emphasizes that people should pay attention to symptoms like chest discomfort, dizziness, or unusual fatigue, and seek medical help if needed.

Advocates for patients are calling on UCHealth to end its practice of filing lawsuits over unpaid bills, after a 9News report found that the state's largest healthcare provider has sued more of its patients than has any other major provider.

Dana Kennedy, co-executive director of the Center for Health Progress, said the vast majority of patients are not trying to get out of paying their bills.

She said many patients taken to court would have qualified for financial assistance.

"In an emergency, you may end up at a UCHealth hospital," said Kennedy. "And the last thing that you want to worry about is if you are going to be getting sued. You want to be able to focus on your own health and healing."

A spokesperson for UCHealth - which recorded nearly $840 million in 2023 profits - said lawsuits are only filed as a last resort when patients don't pay, and are necessary to remain financially sustainable.

Not all health providers turn to lawsuits.

In response to similar complaints, lawmakers in Maryland recently passed a measure requiring hospitals to pay back low-income patients they sued who would have qualified for free care.

Erin Ostlie-Madden is a physician assistant and volunteers with Care Not Courts, a campaign to end medical debt lawsuits.

She said the practice hurts people already struggling financially, just because they sought medical care.

"They have to take time off of work, which can additionally harm them financially," said Ostlie-Madden. "They might need to hire a lawyer. If the lawsuit goes through, they can have their wages garnished."

State lawmakers have passed protections to ensure that patients can access financial assistance.

But Kennedy said, as anyone who has tried to navigate hospital websites and telephone systems knows, they don't always make it easy.

"They are required by law to provide community benefit," said Kennedy. "And the practice of suing people in communities does not support the health and healing of patients, it really causes more harm to all of us in Colorado."




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