FRANKFORT, Ky. -- Tomorrow, the Supreme Court hears oral arguments in cases that could decide the fate of the Affordable Care Act. Health coverage for more than a half-million Kentuckians is at stake, as well as millions of dollars in rural hospital revenue.

More than a dozen states are asking the court to repeal the 2010 law that overhauled the private health insurance market and expanded Medicaid. Dustin Pugel, senior analyst at the Kentucky Center for Economic Policy, said before the ACA, Kentucky's uninsured rate was in the double digits. But Medicaid expansion opened coverage to hundreds of thousands - many for the first time.

"And they were able to get care for chronic conditions," Pugel said. "There was a lot of tobacco cessation counseling; there were cancer screenings. People were able to get old injuries looked at for the first time. And a lot of research showed that it saved lives."

ACA opponents believe the "individual mandate" - requiring people to have health insurance - is unconstitutional. They argue because a previous court struck down the mandate, the entire law should be repealed. The Supreme Court is expected to make its decision by next summer.

In addition to allowing coverage for people with pre-existing conditions, Pugel said the ACA has had positive ripple effects on local economies.

"[Between] 45,000 and 50,000 jobs could be lost just by pulling that $3 billion in federal dollars out of our economy - some of those in healthcare, but also in other industries, like finance and construction," he said.

Pugel said eliminating the ACA would be especially problematic during the pandemic, when many people are getting sick or may have coronavirus complications that require long-term care.

"Having less uncompensated care because a lot of your patients are covered by Medicaid, definitely helped keep their doors open, and you know, could be the tipping point in a hospital's decision on whether or not to stay open," he said.

A 2019 University of Kentucky study found the number of Kentuckians who received colon cancer screenings after Medicaid expansion jumped by 230%, compared to before the ACA.


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About 200,000 kids in Michigan have asthma, and nearly five million suffer from the condition nationwide. Research from Michigan State University shows school-based asthma therapy helps kids manage their symptoms while reducing medical costs. According to the study, school-based therapy relies on collaboration between school staff, nurses, health care providers, insurers, pharmacies, and families.

Kimberly Arcoleo, Michigan State University nursing professor, said the program began as a randomized controlled trial in Rochester, New York in the late 90's. It was launched by a doctor who noticed the same children repeatedly visiting her clinic for asthma treatment - often missing school.

"She came up with actually the very simple idea, on the face of it, to have the school nurses give the kids their asthma controller medications during the school day," she said.

Arcoleo added that the program allows kids to get at least one of their two recommended doses of asthma medication at school. She said that the therapy costs $1,500 per student but saves up to seven thousand in medical expenses by reducing asthma symptoms.

Eighteen U.S. states have passed legislation allowing schools to give out common asthma medications. Michigan has guidelines for school-based asthma plans, but not always asthma therapy. Arcoleo says an unpublished study shows school-based asthma therapy reduces the amount of time students spend away from the classroom, while improving their behavior.

"So, they're sleeping better at night. They're not waking up cranky and irritable - and so therefore they're not acting out as much in the classroom, or on the bus," she continued.

Arcoleo said team is using six years of data to evaluate the cost of asthma therapy in schools - including medical expenses, staff time, and caregiver work loss. She expects results sometime this year.


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About one in four adults and one in five children suffer from seasonal allergies in Maryland, and experts have tips on how to treat them. You may know the feeling - the runny nose, sneezing, coughing and itchy eyes that come with spring allergies.

Dr. Jody Tversky, associate professor with Johns Hopkins University's Division of Allergy and Clinical Immunology, explained allergic reactions happen when you come into contact with an allergen that prompts the body to produce chemicals called histamines, creating the uncomfortable symptoms. Tversky says nasal allergies in particular can make day-to-day activities much harder.

"Folks with allergies of the nose and sinus tend not to be life-threatening, which is a good thing. But they can cause lots of suffering. Headaches, poor concentration, poor sleep, inability to sleep or breathe through the nose. It's like walking around with a constant cold or sinus infection," Tversky said.

UnitedHealthcare has a fact sheet on fighting seasonal allergies. It says you can run the air conditioners in your home or car, shower before bed, and use air purifiers to reduce pollen levels.

If preventive measures don't work, over-the-counter medication can provide some relief.

Dr. Greg Carvenale, chief medical officer with UnitedHealthcare, said those may not always be effective, and recommends giving them a little time to kick in.

"Taking the same medication and expecting a different result, as the old saying goes, likely won't be successful. So if it's been a week or two of you having continued symptoms without relief of taking some of the over-the-counter medications, it's probably time for you to see your health care professional," he explained.

He also recommended avoiding allergens by staying indoors on windy or high-pollen days between the hours of 5 a.m. and 10 a.m.

Black Maternal Health Week runs through April 17th, and according to the American Heart Association, heart disease is the leading cause of maternal death, in Missouri and across the nation. Black women
are more than three times as likely as white women to die from pregnancy-related heart complications.

Tiara Johnson, a St. Louis resident, was diagnosed ten years ago, at just 25, with peripartum cardiomyopathy or PPCM, a rare type of heart failure in the last month of pregnancy or within five months after giving birth. She says at the time, she was living in Michigan and was initially misdiagnosed before doctors confirmed PPCM.

"Every time it's like, 'Oh it's normal, it's postpartum, it happens to moms.' And the other hospital - where I finally decided, 'I'm going somewhere else, I need a second opinion - and that's where they were able to detect that I was actively in full-blown congestive heart failure at this point," she explained.

Johnson received a heart transplant - but is still paying off the medical bills. She has a 'GoFundMe' page to help. PPCM can mimic pregnancy, so symptoms like fatigue, swelling and being out of breath may signal serious heart trouble and require prompt medical attention. To stay healthy, doctors recommend regular exercise, a balanced diet and avoiding alcohol and smoking.

Risk factors for PPCM include maternal age over 35, high blood pressure, multiple pregnancies and ethnicity, as the condition is more commonly seen in Black women. Johnson emphasized the importance of listening to your body and remembering that self-care isn't optional - it's essential.

"As part of the narrative, you know, as moms, we want to be 'super woman' and do all of the things. But we have to tend to ourselves. Because if we don't care of ourselves first, we can't take care of our children, our spouses or anyone else," she continued.

PPCM affects more than 1,000 women each year in the U.S., though experts say it may be underdiagnosed.