Legislation in Kentucky would give a person who has a terminal illness but is of sound mind the ability to request a medication they could self-administer to end their life at a time of their choosing.

Kentuckians who have traveled to places where medical aid in dying is legal in order to help a loved end their suffering say they support the bill.

In 2019, Deborah McElhannon traveled from Shelby County all the way to Switzerland with her husband, whose metastatic kidney cancer left him in unbearable pain, to receive what she called "compassionate relief."

"Within fewer than 30 seconds he was asleep," said McElhannon. "And in less than another minute he was gone. He had said many times during his illness, 'I just want to go to sleep and end this.' And it was as quick and peaceful as he wanted."

A 2020 Medscape survey found 55% of more than 5,000 doctors said they believe medical aid in dying should be available.

However, the American Medical Association maintains its opposition to this end-of-life option, calling the practice "fundamentally incompatible with the physician's role as healer."

The bill's primary sponsor, state Rep. Josie Raymond - D-Louisville - said the bill offers ways to help terminally ill Kentuckians talk openly and honestly about end-of-life options with their medical providers and families.

"We believe that it's a compassionate," said Raymond, "and badly needed solution for families, for caretakers, for patients, who are suffering unnecessarily."

Jefferson County resident Kate Cunningham and her husband temporarily moved to Washington State last year so he could receive medical end-of-life care.

She explained he was diagnosed with throat cancer in 2016, and after chemotherapy, survived only on liquid nutrition.

Last spring, he was diagnosed again, this time with an untreatable form of esophageal cancer.

"We don't treat our pets that way," said Cunningham. "We should not treat loving partners that way, just force them to starve themselves to death to rid themselves of terminal illness."

In a 2020 Gallup poll, nearly three-quarters of Americans said they support the option of medical aid in dying, for themselves or loved ones.

Eleven jurisdictions have already passed laws to legalize it.

During National Health Center Week, health-care advocates are highlighting the work Community Health Centers are doing to improve access to care throughout the state.

More than 600,000 Missourians turn to Community Health Services for primary care and preventive services - as well as dental, mental-health and substance-abuse services.

Steve Douglas - director of marketing and public relations with ACCESS Family Medical and Dental Clinics in Neosho - said their focus is underserved populations, including people without health insurance or gaps in coverage.

"We're able to get them a lot of care they can't get any other place," said Douglas. "And if we can take care of a debilitating health issue, or a toothache, whatever it may be, they can get back into the workforce and provide for their family and keep them off of other government assistance programs."

Nearly 75% of Missourians served by CHCs have incomes at or below 100% of the federal poverty level. About one-in-four lack health insurance, and nearly half have Medicaid.

Douglas said state and federal funding are critical to their work, especially in rural communities where medical care is more scarce. He pointed to programs such as the National Health Service Corps, which helps connect medical professionals to jobs in underserved areas.

"We need incentives to get the very best providers that we can possibly have," said Douglas. "The people that are in our region deserve the same quality of health care they might see in Los Angeles. So support grants that help us to recruit and train great talent are just vital."

During National Health Center Week, the Missouri Primary Care Association and Community Health Centers are celebrating a $150 million investment in the 2023 state budget that will help expand services.

Health advocates are hailing the new Inflation Reduction Act, saying it would be the biggest health-care reform since the Affordable Care Act.

The House of Representatives is expected to vote tomorrow on the bill, which already has passed the Senate. Anthony Wright, executive director of the Health Access California, said it includes many proposals activists have pursued for years.

"It would allow the government to negotiate down prices for the most expensive drugs," said Wright. "It would cap Medicare costs for medications, and it would require rebates if prices rose greater than the rate of inflation. That would help millions of Californians."

The bill also would extend subsidies from the American Rescue Plan that help people afford health care. Without the extension, Wright said he predicts the average Covered California enrollee would see an 82% increase in premiums - a jump of about $1,000 per year.

Bianca Blomquist - California policy director and Northern California outreach director for Small Business Majority - said more than half of people enrolled in ACA-subsidized health plans work for or own a small business, or are self-employed.

"The provisions in this package are crucial for the equitable recovery of small businesses in California," said Blomquist. "And we urge Congress to advance a vote on this legislation quickly."

The American Rescue Plan capped CoveredCA premiums at 8.5% of income. That is set to expire at the end of the year unless the Inflation Reduction Act becomes law.

Backers of a bill now in the U.S. Senate contended it will address rising health care costs and could provide Americans with some relief.

Part of the Inflation Reduction Act would allow Medicare to negotiate directly on prescription drug prices in 2023, and cap out-of-pocket drug costs for Medicare patients at $2,000 a year. It comes a month after Gov. Ned Lamont expanded the state's Covered Connecticut program to adults without children.

Jim Manley, board member of Consumers for Quality Care, noted rising out-of-pocket costs are a chief concern.

"The issue comes down to caps on copays, rising deductibles and prescription drug copays," Manley explained. "Caps on copays are largely absent from the current health care bill that the Senate is going to take up this week. And so, that's been driving out-of-pocket costs higher and higher for more and more Americans."

In the group's new survey, 45% of Americans said their out-of-pocket costs are far too high, and more than 70% feel health care costs are increasing "much more than other things they need." The Urban Institute said one in 10 people in Connecticut, and 13% of Americans overall, have past-due medical debt.

Manley feels while the issue is important, it will not be a dominant factor in the November midterm elections. However, he believes a change is needed. In the survey, 60% of people said they skipped or delayed medical treatment because it is so expensive.

"Health insurers have shifted costs onto patients through higher deductibles and out-of-pocket costs," Manley pointed out. "That's proven to be a real problem for the American consumer. It is leading them to either skip the care and/or go into medical debt. Medical debt is increasingly rampant throughout this country."

For now, the Affordable Care Act outlines out-of-pocket caps, but Manley believes they should be updated. His group also is backing a cap on the price of insulin, which according to a 2020 study is much higher in the U.S. than in most countries.