The federal mandate is clear: Kentucky either creates its own online marketplace to help its citizens find and qualify for health insurance … or it moves aside and the federal government takes over.
These online marketplaces, known as exchanges, are required by the federal Affordable Care Act, which was recently upheld by the U.S. Supreme Court. That’s a fact. The only question is: who runs it? Us, or Washington, D.C.?
Equally clear is the best answer to that choice: Kentucky – not the federal government -- should manage its program.
So last week I signed an executive order establishing what’s called the Kentucky Health Benefit Exchange.
Beginning in 2014, the exchange required by federal law will provide one-stop shopping for Kentuckians to enroll in qualified health care plans or through federal and state programs like Medicaid and KCHIP. It also will be the place where employers can enroll their workers in health plans, small businesses can qualify for tax credits and individuals can qualify for tax credits and subsidies to help pay their premiums.
My executive order also established an 11-member Exchange Advisory Board whose members will be announced by mid-August. And it sets in motion six upcoming forums around the state beginning July 25 with insurers, providers, agents, consumers, employers and advocates to educate the public on insurance reforms and to solicit input on the development of a Kentucky exchange.
My decision followed the recommendations of multiple stakeholders – including business groups, hospitals, insurers and health care advocates … groups with as varied points of view as the Kentucky Hospital Association, the Kentucky Chamber of Commerce and Kentucky Voices for Health.
They have argued loudly and clearly that they don’t want the federal government running this program for Kentucky.
Yet when it came time to find office space to house the program, a legislative committee – voting strictly along partisan lines – tried to block the creation of the exchange by rejecting that proposal. I overrode their action and authorized the Secretary of Finance to enter into the lease.
When are we going to get partisan politics out of policy discussions?
The Affordable Care Act is neither perfect nor the end-all solution to health care reform. But it’s a start, and it’s the law. Regardless of your political affiliation, Kentucky and all other states are under federal order to create benefits exchanges for access to coverage for all citizens.
And with Kentucky’s high rates of cancer and other chronic diseases, this exchange will help our citizens find affordable, quality health care that can help them get on a path to wellness.
We can either hide and let the federal government run this program, or we can step up.
I am determined that Kentucky will not fall behind in the implementation of our state health care exchange.
People who care about Kentuckians know they need help. And that’s what we’re going to give them.
Whether it’s a 20/20 news show or a made-for-TV movie, too often the face of our state is that of a person missing a mouthful of teeth.
It’s an unfair stereotype, but there’s little doubt Kentucky has a serious problem with dental health.
Two years ago we began an aggressive effort to reverse that trend. Last week we unveiled another step, one that could change the lives of 25,000 children.
The impact of poor oral health – especially for our children -- is much greater than an unflattering national image.
Dental problems affect everything from nutritional choices to speech development to performance in school. Children with chronic pain in their mouths find it difficult to do well in school, especially if they have to miss class. And poor oral health can lead to more serious health conditions.
The new program is called “Smiling Schools,” and it has three parts:
• One, over the next year a protective tooth varnish treatment will be applied to the teeth of children in first through fifth grade at 80 schools in 16 counties in Eastern Kentucky. The fluoride varnish prevents decay, slows the progress of existing decay and reverses the beginning steps of decay.
• Two, the Department for Public Health will conduct outreach in that region to increase public awareness of the importance of children’s dental health.
• And three, the local health department nurses specially trained to apply the varnish will examine the children for other dental problems and refer those who need additional services to dentists.
It’s a one-year pilot program funded from two sources: $250,000 from the state General Fund, and $1 million from the federal Appalachian Regional Commission, via a grant to the Kentucky Department for Public Health.
A similar program is in its fourth year in Clark County, and it has produced incredible results.
The new program is part of the “Healthy Smiles Kentucky” initiative I kicked off in October 2009.
The biggest goal was to increase the number of dentists who treat children. With a variety of partners from the dental colleges at the University of Kentucky and University of Louisville, the state’s Oral Health Program is developing new training in pediatric dentistry that should be available later this year.
In addition, last year we awarded grants that helped many communities establish local coalitions that have been increasing access to dental care through new programs tailored to those communities.
Next year those coalitions will be able to apply for portable dental equipment to bring care directly into those communities.
The way I and many others see it, an investment in dental care is an investment not only in the quality of life of our individual children but also in the long-term economic success of this state.
$1.3 billion in taxpayer savings.
550 new jobs.
More effective health care for more than 800,000 Kentuckians.
That will be the impact of a new era we kicked off this week in Kentucky’s Medicaid program, one that taps the private sector to increase efficiency, innovation and effectiveness.
It’s called the “managed-care model” of delivering services, and we are expanding it statewide.
The benefits for taxpayers and Medicaid recipients alike will be tremendous:
Savings: New contracts signed with three new managed-care organizations this week will save taxpayers $1.3 billion over three years, including $375 million in the General Fund. In addition, a new annual contract with Passport, the state’s only existing managed-care organization, will save $37.6 million ($10.5 million in General Funds) in the first year.
Fiscal stability: With the Medicaid budget rebalanced this fiscal year, the pressure to “fix” Medicaid by making additional cuts in unrelated areas like education, public safety and job creation will be alleviated, both now and in the future. Like I promised, we rebalanced Medicaid within the program itself.
New jobs: Nearly 550 new jobs will be created in Kentucky, as these companies hire new employees over the next several months to administer their contracts.
Better health outcomes: The delivery of health care services – and thus the health of nearly one in five Kentuckians who access care through Medicaid – will be improved.
The contracts are with three managed-care organizations new to Kentucky and an existing company. The new companies:
• CoventryCares of Kentucky – a Medicaid product of Coventry Health and Life Insurance of Delaware, which provides services in eight states.
• Kentucky Spirit Health Plan – a subsidiary of Centene Corporation, which is based in Missouri and provides services in 12 states.
• And WellCare of Kentucky – a part of WellCare Health Insurance of Illinois, which provides services in seven states.
Those organizations will begin coordinating physical, mental and dental care statewide beginning Oct. 1 for more than 560,000 Medicaid recipients across the state, except for the region currently covered by Passport Health Plan.
Passport has had its contract renewed.
Passport has been providing services to 170,000 Medicaid recipients in Jefferson County and 15 nearby counties for more than a decade. Its work has proven the effectiveness of the managed-care model, and there will be no break in Passport’s service or coverage.
Taxpayers can rest assured that we will have strong oversight over the work of all these companies in Kentucky. We have built strong patient-protection provisions into the contracts, and as you know in January we created a new Medicaid Managed Care Oversight Branch.
There will be bumps in the road, but we are working closely with these organizations to ensure an orderly transition of care and to make sure that taxpayer dollars are well spent.
The goal of managed care is not just to lower overall costs but to also improve outcomes, reduce unnecessary medical services and promote wellness and healthier lifestyles.
The emphasis is on prevention as well as coordination of care.
Some 46 percent of Medicaid caseloads in this country are under managed care.
It’s the model that most other states have either adopted or are moving toward – 20 states expanded their managed care programs in the last two years, and 19 have indicated they will do so in this fiscal year.
Kentucky has joined the list.
An average of 82 Kentuckians fall victim each month to drug overdoses.
And more Kentuckians now die from drug overdoses than car wrecks.
To agree with the words of our law enforcement officers, medical professionals and coroners… what has long been a problem has now become an epidemic.
This morning I was invited to testify before a congressional panel on the growing prescription drug crisis decimating Kentucky and our nation.
I said that when faced with this epidemic, Kentucky has responded aggressively.
We’ve ramped up enforcement. We’ve expanded the availability of treatment. And we’ve implemented high-tech monitoring and record-keeping while working to share that information with other states.
KASPER, Kentucky’s web-accessible drug monitoring system, assists doctors in tracking dispensed prescriptions and helps police investigate the diversion of pills to illegal sales.
In 2006, the White House recognized KASPER as one of the nation’s flagship prescription drug monitoring programs, and it is used today as a model for other states.
But just as Kentucky has tightened its net, illicit drug users have found ready supplies of prescription drugs in other states with looser regulations – and we need help to stop them.
What is needed – clearly – is an aggressive nationwide response, one that recognizes that this country’s prescription drug strategy is only as strong as the weakest link in the chain.
My testimony stressed three points to implement this nationwide strategy:
1. I urged Congressional leaders to continue providing resources to the Harold Rogers Prescription Drug Monitoring Grant Program so as to continue prescription drug monitoring and data sharing among states;
2. I also urged them to mandate training for prescribers of controlled substances to bring further awareness and education of the risks of drug addiction and fatal overdoses to both doctors and patients;. and
3. I urged Congress to have the Department of Justice focus more attention and resources on Florida, especially South Florida, to stop the flow of illegal prescription drugs to other states.
Some 60 %percent of the prescription drugs sold and consumed illegally in Kentucky come from loosely regulated pain clinics in Florida, with each trafficker bringing back, on average, more than $10,000 worth of drugs.
These pill traffickers are not amateurs. They are sophisticated, well-organized operations.
The fight against them must be well-organized as well.
Therefore, I, in both personal conversation and by letter, along with Congressman Rogers, Lt. Gov. Mongiardo and Attorney General Conway, have been urging Florida Gov. Rick Scott to implement a system in his state.
Although Gov. Scott was initially against the system because of privacy concerns, I am excited to announce that this morning he advised me privately and at the hearing that he was moving ahead with the implementation of a prescription drug monitoring system.
This is great news for Kentucky and could save thousands of lives.
But that program is just a start. And it is just one piece of the strategy.
This is a national problem that demands national solutions.
The sooner we come together to recognize that, the greater our success will be.
And I’m committed to standing up in support of our Kentucky families, no matter where that takes me. Even to Washington D.C.
In an age of advanced technology, hand-held videogames and all the many electronic gadgets that are available to our children, it’s hard to reconcile the relative wants of most children with the extreme needs that still exist for many.
Today I addressed hundreds of activists who advocate on behalf of children’s needs at the 7th Annual Children’s Advocacy Day at the Capitol.
Throughout my career, I too have fought for Kentucky’s children and their families and have continued to do so as Governor.
Recent headlines have broadcast acts of cruelty among children based on bigotry and have spurred nation-wide “anti-bullying” campaigns. Back in April 2008, I signed “The Golden Rule Act”—legislation that required “anti-bullying” policies to be put in state public schools to prevent harassment and forms of intimidation among students, including cyber-bullying.
This legislative session one of my top priorities, and one that has been championed by our First Lady, is HB 225, the Graduation Bill—a measure that raises the mandatory high school attendance age to 18.
Passing HB225 will not only increase the number of high school graduates, but it will send a message to our children that education is a priority and the foundation of their future success.
And in order for a child to educate their mind, they need to have a healthy body.
Since Nov. ‘08, we’ve stepped up efforts to ensure health coverage for our poorest children. To date, we have tracked down and enrolled almost 52,000 children who were eligible for coverage through programs like the Kentucky Children Health Insurance Program (KCHIP) and Medicaid.
At the same time, we have made great strides toward addressing fundamental problems in Kentucky that increase health care costs as a whole—including obesity, smoking and dental problems in our children.
Recently, we expanded the Kentucky Tobacco Quit Line to offer counseling services to younger Kentuckians between age 15 and 17. Previously, the service was available to those over 18.
In 2009, we launched a 3 year initiative to improve quality and access to dental care, especially for the children of Eastern Kentucky.
And this year, I proposed legislation to establish a Kentucky Child Abuse and Neglect Fatality Review Panel because the loss of a child at the hands of an abuser or as a result of neglect is unconscionable.
Still yet, we can do much more for our children.
As a father and grandfather, it’s heartbreaking to know that there are kids who will go to bed hungry or sick; children who don’t have a bed to sleep in or a parent or caregiver who doesn’t take an interest in their child’s school work.
Together we can and must work to make Kentucky a place where all children can get the healthy start they require, the education they deserve and the overall proper care they need to be happy, productive citizens of this Commonwealth.
Kentuckians access health care through Medicaid.
That’s nearly one in five citizens in our state, a number that has grown tremendously over the last few years – not because we’ve expanded eligibility, but because this global economic recession has cost so many of our families their jobs and health coverage.
In fact, over the last two years we’ve added nearly 3,000 Kentuckians a month to the Medicaid rolls.
And these Kentuckians use benefits offered through Medicaid to simply stay afloat during tough times.
But many of those benefits are now in jeopardy because of a significant hole in the Medicaid budget, a hole created when financial help from Congress was less than anticipated when Kentucky’s current two-year budget was put together.
To fill this hole, I’m proposing a limited, budget-neutral rebalancing plan that moves $166.5 million from the 2012 Fiscal Year Medicaid budget to the 2011 Fiscal Year.
This plan will not only plug our existing gap but also allow us to take advantage of a temporarily higher federal match rate in the current year.
If this action is not taken and this hole is not filled, we have two options:
One, we will have to cut some $600 million in health-care services by July1.
Or two, we will have to cut provider reimbursement rates by nearly 30 % for the remainder of Fiscal Year 2011.
Neither option is palatable.
Both would have a devastating impact on our families and health care providers. And, I believe undoubtedly, would further cripple this state.
Yesterday, legislators and health care providers from across the state joined me in a press conference to relay these cold facts and put forth this proposal.
But our proposal isn’t (contrary to some belief) just a short-term fix. It’s part of a multi-pronged strategy.
Recently the Cabinet for Health and Family Services created a new Managed Care Oversight Branch as well as sent out requests for information as a way to move forward on several managed care initiatives.
We believe that installing a better delivery model will improve care as well as cut costs in the long term.
Medicaid services are critical to our families. And as this program continues to grow, we have to be both smart and aggressive about controlling its costs.
To date we’ve already taken steps to reduce fraud and abuse … to reduce the unnecessary use of medical services, treatments and ER visits … and to manage pharmacy costs.
We’re also taking assertive steps to address fundamental problems that increase health care costs as a whole – including obesity, smoking and children’s dental care.
And now, with this legislative proposal, we must act to protect the services that we already provide and that our families desperately need.
More than 51 %
of Kentucky’s smokers made at least one attempt to quit smoking in 2009.
But quitting such an addictive habit is neither simple nor easy.
Today we kicked off an in-depth program that will give smokers who qualify for Medicaid both the resources and the support they need to shake off the scourge that is destroying not only their individual health but also the physical and financial health of this state.
This program will feature a complete, holistic approach:
• An initial assessment of the patient will measure tobacco usage, readiness and willingness to quit, coping skills and barriers to quitting.
• Patients will then enroll in a smoking-cessation program, such as the Kentucky Tobacco Quit Line or Cooper-Clayton Smoking Cessation course.
• If necessary, they will be prescribed nicotine replacement therapy (NRT) products or tobacco cessation medications. These include things like nicotine gum and lozenges, as well as prescription pharmaceuticals. As of today, the Medicaid program in Kentucky will cover these products.
• And patients will be directed to enroll in counseling programs that assist those who are trying to kick the habit.
Funding for the program will come from state and federal resources. Earlier this year, I asked the Kentucky General Assembly to approve Medicaid coverage for smoking cessation. They agreed, and the 2010-2012 biennium budget allocates $1.5 million for each fiscal year.
Federal matching funds are projected to equal $4.7 million in FY ’11 and $3.7 million in FY ’12.
This level of funding demonstrates not only our commitment to the program but also our belief in its chances of success. We believe the investment will more than pay off in long-term reductions of chronic disease and health care costs.
Although our smoking rate has declined over the last eight years, Kentucky along with West Virginia still leads the nation in the percentage of adults who smoke – about 25.6 %. We also are 2nd in the nation in number of pregnant women who smoke and potentially damage their babies’ health.
Health care costs related to smoking reach $1.5 billion a year in Kentucky.
Nearly 8,000 Kentuckians die prematurely each year because of diseases related to tobacco use, and many more suffer from chronic disease -- painful illnesses that steadily erode their quality of life.
Each year, the number of Kentuckians sickened by these degenerative illnesses steadily increases.
Each year, the suffering continues.
But many of these diseases could be addressed – and often prevented -- through simple lifestyle changes.
Eating healthier, exercising regularly and – most importantly – avoiding cigarettes, chewing tobacco and other tobacco products.
Quitting smoking is one of the single-most important lifestyle changes one can make to improve one’s health.
The program we unveiled today will help those who want to quit find success … and better health.
With the entire globe mired in a deep economic recession, keeping Kentucky’s state budget afloat has been a full-time mission requiring a steady, strategic and day-by-day approach.
In the wake of the Education Jobs and Medicaid Assistance Act passed by Congress and signed by President Obama in mid-August, the time for aggressive action is again upon us.
The news is both good and bad.
The good news concerns school funding, and an unanticipated infusion of cash.
The bad news concerns the Medicaid budget, and a new funding hole created when the General Assembly greatly overestimated the federal help coming our way in the Medicaid program.
First, the good news.
Kentucky is getting $134.9 million from the Education Jobs Fund, money that we are sending directly to school districts through our current SEEK formula. It must be used to retain, hire and rehire school personnel -- including teachers -- and to support related expenses that were in jeopardy because of funding pressures.
In short, 100 percent of these funds will be used to support classroom instruction, which has been a high priority of mine throughout this crisis.
Our schools haven’t faced the disastrous cuts inflicted in other states because we acted aggressively early in this financial crisis to both cut state spending and yet protect education spending from those cuts.
Still, as school officials will tell you, these new funds – though one-time in nature – are desperately needed.
I urge our schools to be cautious and conservative with these funds because they will not be available next fiscal year, which promises to be even more challenging from a funding perspective.
Now for the bad news.
If you remember, the two-year budget passed by the House and the Senate earlier this year contained a $238 million assumption: that Congress would pass legislation to increase federal funding for state Medicaid programs set up to provide health care to low-income families, children, pregnant women and the disabled.
My proposed budget did not include this “money-to-come-later” line item. While aware of the possibility of an extended higher Medicaid match rate, I was not confident that it would happen.
Instead, I made tough decisions to cut spending, and I took the bold step of proposing new, recurring revenue in the form of limited expanded gaming.
As we all know, the legislature did not agree with my more conservative approach. And although they also failed to agree on how to balance the budget in the regular session, they came together in special session to pass a budget that counted on the extra $238 million.
Unfortunately, while Congress did indeed increase federal funding, the increase was limited in nature – only about 58 percent of what was assumed.
Instead of $238 million, Kentucky is getting a little more than $137 million.
That creates, in essence, a hole of $100 million in state funding for Kentucky’s Medicaid program. With state funding matched on a roughly 4 to 1 basis by federal funds during this period of enhanced funding, we’re left with a program shortfall of about $470 million.
By June 30, 2011, we have to account for that gap.
Two things will make that especially difficult.
One, because so many people in Kentucky have lost their jobs because of the recession, over the last two fiscal years we have added nearly 3,000 people a month to the Medicaid rolls.
And two, the budget I introduced already contained a series of cost-containment measures – $125 million in state funds alone, or total program reductions of about $584 million.
Our Cabinet for Health and Family Services has announced a first round of such measures, including reducing the unnecessary use of medical services, treatments and ER visits … eliminating the ability of patients to “doctor-shop” in order to obtain unnecessary drugs … managing pharmacy costs more effectively… increasing efforts to collect payments from liable third parties for Medicaid services … stopping the practice of paying hospitals for hospital-acquired infections and errors … recouping payments to providers by partnering with the Department of Revenue … and more aggressively identifying fraud and abuse.
We’re working on the second round of actions right now.
Cutting an additional $470 million in program costs could have a catastrophic impact on our people.
Now, I know that the General Assembly has created two groups to focus on Medicaid issues, one of which was set up in the 2010 regular session. These groups – the Medicaid Oversight and Advisory Committee and the Task Force on Medicaid Cost Containment – have been meeting jointly.
So today I called on those groups to immediately begin working on recommendations to address this budget shortfall. With those recommendations, we can then begin to come together to find solutions to this problem.
And time is urgent.
We are just two months into the fiscal year, but already it appears we will need to address the budget again when the General Assembly comes to town in four months.
Over the fall, my staff and I will be watching state revenues closely … and we will be developing scenarios on how to balance a budget that has been unbalanced by federal action that does not match up with the assumptions made by the General Assembly.
This is a huge challenge, but then we’re used to it.
I hear a lot of people talk about cutting the budget and shrinking government.
Talk is easy. The going gets difficult when it comes time to actually “walk the walk.”
Getting the job done takes more than slogans and political sound bites. It takes courage, commitment and leadership. It takes the willingness to step up and make tough decisions, to be honest about fiscal realities, and to think ahead.
For nearly three years I’ve been leading Kentucky through this tumultuous time by combining fiscal discipline with the willingness to make tough choices such as furloughs and lay-offs of political appointees.
And I’ve worked to put policy above politics.
I will continue to take that approach, and I urge others to do likewise.
Kentucky has a problem with its national image.
Whether it’s a 20/20 news show or a made-for-TV movie, too often the face of our state is that of a person missing a mouthful of teeth.
We could object to the fairness of this stereotype -- it has led to ridicule and a misleading generalization of our state’s inhabitants.
And we could put forth for alternative consideration an array of Kentuckians who have made invaluable contributions in areas like science, medicine, literature and technology.
But let’s be honest. We have an image problem precisely because the reality underlying that image does in fact exist.
Oral health care is and remains a major health challenge for this state.
· In 2004, Kentucky led the nation in missing teeth among people age 65 and older.
· Some 27 percent of Kentuckians of all ages had lost six or more teeth to decay or gum disease, compared to nearly 18 percent nationwide.
Not surprisingly, these problems start at an early age:
· In 2001, about half of Kentucky’s children had decay in their primary teeth.
· 46.8 percent of children ages 2, 3 and 4 had untreated problems such as a cavity or a missing tooth. That’s more than twice the national average.
· And nearly 40 percent of these children had never seen a dentist.
Yes, the statistics are real.
They’re also unacceptable.
Dental problems are preventable. They just have to be a priority.
Today, we begin making them a priority with a three-year initiative that aggressively focuses resources on the causes of Kentuckians’ poor dental health, especially our children.
The Kentucky Oral Health program within the Cabinet for Health and Family Services has earned three federal grants totaling just over $1.6 million.
One grant is from the federal Health Resources and Services Administration. The other two come through the Appalachian Regional Commission.
We will use these grants to undertake a three-part strategy to improve the access of young patients to dental care and to improve Kentucky's overall dental health picture by tackling root causes.
One of the biggest challenges remains access. There are too few dentists, particularly pediatric dentists. In fact, only 28 of Kentucky’s 120 counties are home to a pediatric dentist. In addition, a limited number of dentists accept Medicaid patients. And, in many areas, transportation is inadequate.
Another challenge is attitude and education. Not enough people truly understand the link between good oral health and overall health.
And another challenge, quite simple, are poor habits. We, collectively, must develop better oral hygiene practices and better nutritional habits.
Now, how are we going to do this?
The first piece of the puzzle involves increasing the number of Kentucky dentists willing and able to treat patients under 6. Child patients pose challenges, but unless a dentist is specializing in pediatric dentistry, he or she receives only limited training in dealing with them.
The Kentucky Oral Health program, working with key stakeholders, will develop a curriculum that teaches effective pediatric technique.
A key strategy in the multi-faceted approach used in Washington state, this technique will be known as the “ABCD” initiative (or Access for Babies and Children to Dentistry).
Once Kentucky's curriculum is finalized, a series of seminars, Web-based training modules and mentors will assist local practitioners.
Incentives will also be offered to providers, at no cost to them, in the form of continuing education credits that all dentists currently must earn every two years.
So that's step one, getting the right training in place and making it available to dentists statewide.
The second step involves targeting counties in Appalachia, especially the 40 counties designated as “distressed,” with extra efforts.
The ARC funds can help financially offset the time taken off from practice for those dentists who participate in the ABCD training initiative.
Another component involves creating local coalitions to create and tailor oral health care programs to the specific communities.
This recognizes that because problems differ from county to county, what works in one county might not work in another.
These coalitions will work with local public health departments and other partners to assess dental health on the community level, propose and implement solutions and – incidentally – be eligible for additional benefits from the grants to support local priorities.
We anticipate being able to fund up to 12 such coalitions, which typically will include one county but could cross county borders.
Plans developed and tailored to the local level are more likely to bring real and sustainable progress.
And our third component, which will happen in year three, is to buy portable dental equipment that will be made available to ARC-distressed counties to increase access and utilization of dental services for both adults and children.
This is not a mobile treatment van like we usually envision, but instead the latest portable equipment that can provide a full array of dental services in nontraditional treatment settings like schools, child care facilities or senior citizens centers.
We expect to have at least two sets of this equipment initially, with hopes of obtaining more later.
Now, a few things about this oral health care initiative should be obvious.
One, this effort will have a lot of partners, on the local, state and federal level. That’s appropriate given the systemic nature of the problem, and it will increase our chances of success.
I want to acknowledge the hard work of our people at the Department for Local Government in helping to prepare the grant applications for working with ARC to secure funding.
I also want to thank our Congressional delegation for making sure ARC is awarded funds.
The second thing that should be obvious is that this problem won’t be eradicated overnight.
However, we do anticipate and expect to made measurable progress with this program. Thus we have set some specific goals.
For example, within three years of the start of the project, we expect to increase the number of dental visits by children up to 6 years old by 16 percent, as measured by Medicaid service reports.
We also want to reduce the decay rate by 15 percent in children in the distressed counties.
Other goals predict other outcomes.
The third realization is that this isn’t just a dental program, it’s a health program.
Teeth aren’t just for looks, and good oral health isn’t just cosmetic. It’s a key factor in overall health.
Poor dental health has impact far beyond lack of a pretty smile.
Studies show children with untreated pain and infection because of tooth decay often choose other foods, affecting their overall nutrition.
They also can have poor speech development; and they have lower performance in school.
You can’t learn under those conditions, especially when you miss school.
This program dovetails well with one of my highest priorities as governor, which is getting our children off to a good start in life.
Previously we began work on a program to bring health insurance to the tens of thousands of children whose families don’t have any.
Already more than 25,000 additional children previously uncovered have been signed on to Medicaid or K-CHIP, and that number continues to grow.
We’ve also created a task force to streamline our network of early childhood education and health services.
The simple fact is we owe our children the promise of a productive life.
Making good on that promise is a moral obligation, but it also will pay great dividend in creating a stronger state.
You know, we have severe financial challenges in state government, just like every state does.
But a down economy is no excuse. We must fight for our families. We must improve the lives of Kentuckians. We must move forward on fundamental problems holding us back.
Kentucky health officials have been closely monitoring developments involving the 2009 H1N1 strain since earlier this year, when officials around the world began to take note of its quick spread and potentially devastating impact.
Fortunately, we now know a whole lot more than we did last spring about this strain – who it targets, how it works – and we were fortunate that the number of cases of H1N1 in the spring and summer were relatively mild in severity in the Commonwealth.
But with schools back in session and the traditional flu season around the corner, we must be prepared for the H1N1 outbreak to potentially grow in severity and numbers.
Recently we announced the first flu-related death in Kentucky involving a Fayette County woman in her 50s. This woman had significant underlying health conditions – she didn’t just have the flu – but nevertheless this case reminds us of the seriousness of the situation we have on our hands.
So, there is no reason to panic, there is definitely reason to be concerned … and, as importantly, to be prepared.
The flu – no matter what the strain – has long had the ability to cause serious illness, and an estimated 36,000 Americans, including 400 to 500 Kentuckians, die each year from complications related to the flu, which by nature is an unpredictable illness.
What are we doing to help?
First, I recently summit of health professionals, educators, business officials and emergency responders to discuss the flu and the need for a coordinated, flexible and aggressive response.
More than 1,000 people attended.
The second action is a back-to-school campaign that stresses a simple approach – the best prevention is doing the basics.
Children are being instructed to wash their hands, cover their coughs and stay home when sick.
It’s the same approach we’re pushing to the general public, because our response to the flu begins at the individual level. All of us should assume – just like we do every year – that we may be exposed to flu any time we're out in public.
School officials are also taking other precautions – such as wiping down desks regularly -- to limit its spread.
Because we know more about the flu’s symptoms, we’ve changed strategies a bit.
Back in the spring, public health officials were recommending – with the guidance of the federal Centers for Disease Control and Prevention – that schools and child care programs consider closing if they had just a handful of cases.
What we know now, however, is that the severity of illness caused by H1N1 is comparable to seasonal influenza. So at this time public health authorities are recommending that schools, day cares and businesses approach and treat H1N1 just as they would the seasonal flu.
Our third response deals with antiviral medications, which when taken early can reduce the length and severity of flu cases – or even prevent illness.
At this time, such medications are recommended only for those at the highest risk of complications from the flu.
If this illness becomes more serious and widespread, the state has a stockpile of antiviral drugs on hand that it would make available if a shortage of such drugs occurs in the commercial market.
In addition, we have already requested and received 25 percent of the medicines and supplies that the federal government would supply to the state in a true flu emergency.
Our experts and state agencies have been planning for the “worst case scenario” with pandemic flu for some time. While it doesn't appear that we will experience that with H1N1, there are plans in place to help the state cope if the situation changes.
The fourth response concerns vaccines.
We are working to make sure that a vaccine campaign targeting those at the highest risk from H1N1 will be ready to go as soon as the vaccine becomes available.
The CDC has said states could receive H1N1 vaccine as early as mid-October, and that the first doses should be targeted to pregnant women, caregivers of children six months or younger, health care workers, children from 6 months to age 24 and those with high-risk conditions.
Whereas the flu typically targets older people, the new flu strain seems to have the most impact on a younger population. Seventy percent of those who have been hospitalized with H1N1 in the United States to date have been under the age of 49.
In fact, it appears that at least some older people may have immunity to H1N1.
I know state and local public health agencies are working closely with physicians, hospitals and other providers to step up to the plate on this issue.
The bottom line is that our response – for it to be effective – must be coordinated and it must be comprehensive.
The careful preparation that has taken place in recent years by public health officials and others is allowing us to coordinate the appropriate response to protect Kentuckians
Kentucky is well positioned to respond with further prevention and treatment measures as needed, and we will do whatever it takes to keep our people healthy and safe.