Health commissioner leaves political correctness at the door, talks about getting governor to back anti-smoking measures

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – State health officials didn’t shy away from saying that smoking was one of Kentucky’s top health issues at a recent meeting about population health, and Health Commissioner Hiram Polk went so far as to say they need to find a way to get Gov. Matt Bevin, who says smoking bans are a local issue, to adjust his policy.

Dr. Hiram Polk

“We’ve got to find some kind of landmark we can use there that would be acceptable to the governor and get through the legislature,” Polk told the Friedell Committee for Health Oct. 25 in Frankfort.

Polk called smoking a “political issue” and said solutions include higher cigarette taxes and enforcement of smoke-free areas. He also said he has been talking to Ben Chandler, the new director of the Foundation for a Healthy Kentucky, about ways to get the governor to adjust his stance on this issue.

“It is really rare for somebody in this position to say publicly that ‘I want to try to change the governor’s mind’,” Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News and Friedell Committee member, told the group as he summarized the day. Cross said the 80-year-old Polk, a noted surgeon, is a “guy who speaks his mind.”

Tim Feeley, deputy secretary of the Cabinet for Health and Family Services, noted that Kentucky has some of the highest smoking rates in the nation, along with obesity, cancer and opioid abuse. He called for more smoking and nutrition education.

Drug issues

Polk said since taking office his “time has been overwhelmed with the issues of IV drug abuse.” And that after attending many meetings on the topic, “There are no good ideas about what to do with drug addiction.”

He said the cabinet is working on three opioid initiatives: one that centers around a “healthy living” early childhood educational program, which he hopes to have set up in at least five school districts by fall 2017; a program to increase access to medication-assisted treatments; and beginning this week, a program involving the state’s mobile pharmacy, which will travel around the state upon invitation and share educational literature, pass out free Narcan (naloxone), accept outdated drugs and operate a one-for-one syringe exchange.

There was some question about the state’s requirement that syringe exchanges be one for one. Feeley said, “As of right now, Governor Bevin has endorsed the needle exchange on a local-option basis. He has also stated that he is in favor of a one-for-one needle exchange. . . . We want to do a needle exchange that encourages the individuals to come in and to get into treatment. . . . Some of the thought is that a one-to-one exchange is the best way to do that.”

Cross said the administration’s stance seems to be that only exchanges funded by state grants will have to be a one-for-one exchange. He said this strategy might work to appease the legislators who don’t understand that this is a public health program designed to prevent the spread of HIV and hepatitis C. “We’ll find out during the General Assembly,” he said.

Polk also pointed out the increased health disparities among the state’s African American population and those living in the Appalachian region, though he emphasized the problems in Appalachia.

“The situation in Appalachia is just appalling,” he said. “I think again, Appalachia is more discriminated against than African Americans. If you look at anything. It needs the most help for everything.”

Cross said that while Polk “is not politically correct,” this is “largely a good thing” because public officials often “don’t say what they believe to be fact and try to avoid confrontation. Hiram Polk is not conflict-averse, and we should be thankful for that.”

And as for finding health solutions, Polk boldly reminded those in the room that many health decisions are selfishly motivated.

“We’ve got conflicting and selfish interests of people all over health care, many of which are represented in this room,” he said. The perfect example of this, he said, is the pharmaceutical industry, which successfully lobbied to protect its “massive profits” under the Patient Protection and Affordable Care Act. He also said that the “larcenous nature” of this industry is sure to demand “$1,000 for every single treatment” of the newly developed medication assisted treatment drugs, which the state hopes to promote.

Cross said drug makers argue that their profits finance cutting-edge drug research, but also comprise a powerful lobby that knows how to influence the political system. He said the Kentucky Farm Bureau Federation is likewise a powerful lobby, “which I believe is the primary device by which Kentucky’s tobacco heritage remains in control of tobacco policy in this state. . . . If you can change Farm Bureau, you can change the game.”

Medicaid boss speaks

Medicaid Commissioner Steve Miller briefly reviewed the governor’s proposals for the program and said the cost of the current plan is not sustainable. He said the plan “may not be all the answers . . . [but] what we have been doing, and the way we have been doing it, needs to change.” After the meeting, Miller told Cross that state and federal officials have entered into negotiations about it.

Miller told the committee his agency is working to hold Medicaid managed-care organizations accountable to their contracts, but said they haven’t changed their behaviors.

Providers still struggle with MCOs paying them on a timely basis, if at all. They also struggle with the administrative burden of dealing with five different MCOs. Scott Lockard, public health director in Clark County, asked if the state had considered contracting with only one MCO. Miller said the state wasn’t ready to go that far, but averred, “We don’t need to have five. I think we need to have more than two.”

Raynor Mullins, professor emeritus at the University of Kentucky College of Dentistry, said it is clearly understood that Kentucky’s financial woes are “substantial” and  asked, “When are we going to get serious and start to talk about tax reform?”

Miller said he would leave tax policy to others, but added, “The revenue stream as it exist today is not adequate enough to cover the Medicaid expenditures and other things that need to be done. . . . It is not sustainable as we are doing it today.”

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