insurance means access to health care, what happens if you only have one or neither?

Stay with us as we continue our review of these topics from the past year with our guests.

Louisville Public Media health reporter Morgan Watkins.

Next on Kentucky Health.

>> Kentucky health is funded in part by a grant from the Foundation for a Healthy Kentucky.

>> Today, we are concluding a review of this past season's shows.

We have had wonderful discussions on a diverse number of healthcare topics from our knowledgeable guest.

As always, the aim of our discussions has been to inform and keep us aware of those conditions and things that affect our health and that of our family, friends and neighbors living in the Commonwealth of Kentucky.

Hopefully you'll agree that we have succeeded.

As we wrap up this season, we are looking back at past shows and expounding on how they fit into the overall healthcare narrative.

Today, we're going to look back at shows where we discussed diet and nutrition and Medicaid.

We will review what it means to eat a healthy diet and expand our.

Upon our discussion on Medicaid and health care.

Joining me in this review we have Miss Morgan Watkins.

Miss Watkins is a native of Florida and started her career covering city and county government at the Gainesville Sun.

She moved to Louisville and the Courier-Journal, where she covered national, regional and local news.

Miss Watkins is now part of the Kentucky Center for Investigative Reporting, where she covers health.

The environment for LPN.

Morgan, thanks for being with us.

>> Happy to.

Oh, good.

>> We'll see you at.

>> The end.

>> Food is medicine.

I think that we can all take heart with the attention that is now being paid to what we eat.

This is especially true as we begin to think of food not just as something that we do, but rather as an integral component to our well-being.

The initiation of programs at the state and federal level to minimize the intake of processed foods and control the level of non-nutritive additives is commendable.

Clearly, any efforts directed towards decreasing the incidence and complications associated with obesity, diabetes, and cancer through better control of what we consume is both both laudable and needed to help us understand what we're eating and how to make good choices.

We were joined by Miss Karen McNeese, a registered dietitian with Human resources, health and wellness at the University of Kentucky.

I asked her about the differences between GMO, natural and organic foods and found her response quite insightful.

>> Let's start with natural.

>> Okay.

>> That's a pretty meaningless term to me.

It's very loosely regulated.

There's a lot of loopholes in its enforcement, and it's really a marketing term.

So I tell people, ignore that.

If you see it on a package.

It means nothing.

Then you have GMO, right?

That stands for genetically modified organisms.

Now, major groups like the FDA, the Food and Drug Administration, and Who, the World Health Organization, they have basically come down and said those are safe for human consumption.

There is a lot of controversy about that, though, right?

So I do think there is some room for for debate.

I'm not sure the science is quite settled on that.

>> I read food labels and if you look at the food labels, you may agree that there is a lot of information printed on them and that sometimes it's hard to make good choices based upon what we are reading.

Fortunately, miss McNeese has some suggestions on that also.

>> You're right, and I know a lot of your audience must feel that way.

And I've gotten tricked by a lot of food labels in my day, and so I always like to tell people, even the.

Even the dietician gets tricked.

And if I'm not reading properly or I'm in a hurry and not checking everything out, I get a product home and I'm like, oh, I can't believe I didn't catch that.

But one of the biggest things I tell people is to ignore the front of the package.

That is where all the marketing tricks happen.

All those labels like natural that mean nothing or free from this or that, right?

Again, creating kind of this illusion that it's healthy.

What you want to do is ignore the front of the package, look right at that label with all those numbers on there and the ingredient list.

Now the numbers on there.

You know, I think it's important to look at calories.

Maybe look at I look at added sugar, sodium, maybe sometimes fiber and protein.

Those are probably my big ones to look at on a label, but I often find it more useful to look at the ingredient list.

I really want to see one.

How long is the ingredient list, and does the ingredient list include things that I can identify?

Can I instinctually know what those things are?

Right?

But if there are things that I can't pronounce, I couldn't even begin to tell you what they are even as a dietician.

Then I'm putting that product usually back on the shelf.

So a longer ingredient list with a lot of things you don't recognize is probably a sign that it's low nutrient density and just generally a low, a low quality food.

>> Sometimes our food choices are dictated by the availability of products, the preparation time and cost.

However, there are ways of finding high nutritional value choices from what is available if we are careful.

>> In my mind, those foods include a lot of what we call ultra processed foods.

So those are going to be things like chips, snack foods, desserts, cookies, all those kinds of things, right?

That are yes, very high calorie because they usually have a lot of fat added sugar or refined carbohydrates, but low nutrient density.

That's an example of a food.

That's those, those things.

There's really nothing health promoting or nourishing in it.

Now, I do want to say, though, it's important to me for people to know that eating a cookie because it tastes delicious and you love it is okay.

>> We thank you very much.

I appreciate that.

Okay, I get a pass now.

>> We should all especially.

Yeah, we should all allow ourselves, you know, the, you know, permission to do that.

There is, you know, an inherent value in just the pleasure of food.

So you don't always have to be concerned about that, right?

Especially with special occasions or certain foods you don't eat that often.

So I do want to be sure people understand that.

But these ultra processed foods are a real problem.

And you hear, you know, the Maha movement and places like that talking more about them now.

But these are industrial foods.

Gotcha.

They're not even real foods, right?

The way I explain it to people is I could make, you know, yogurt in my kitchen if I wanted to.

I don't because I'm busy and I'm lazy a lot of the time.

And I'm just going to go buy some plain yogurt, right?

I could also make peanut butter at home.

Right?

But I'm not going to do that.

I'm going to go buy that.

But buying those things in a processed form is not really problematic, right?

Because they're familiar ingredients.

There's very few ingredients.

You could theoretically make it in your home kitchen.

So to me that's the standard.

Now, could I make Cheetos in my kitchen at home?

No, I love Cheetos, but no, I can't make that.

I couldn't even begin to figure out how to make Cheetos, because there are industrial processes and ingredients that I don't have access to in my home kitchen to make that.

So I hope that that's helpful for the audience to hear, you know, how to kind of make that distinction.

How much does this resemble a real whole food versus something that's completely industrial made?

>> At the end of the day, we are left to ponder as to what should we be eating.

This task is not made any easier as we begin to see food as medicine.

After all, who wants bad medicine?

Thanks to Miss Mcniece, there is a sensible approach as to what to put on our plates.

>> What we know about human health and nutrition.

We've known for a long time and it's not going to change.

Okay, I know people feel like it's always changing because that's what the news cycle is designed to do, right?

To get you to feel like things are always changing and we're discovering something new.

But, but we, we haven't and we're not going to.

So the basics are lots of plant foods, fruits, vegetables, beans, nuts, seeds, all of those things, right?

Also grains to some extent, particularly whole grains when we can doing the whole wheat bread, like we talked about doing brown rice or whole wheat pastas, starchy vegetables like potatoes, all very nutrient dense foods.

You also want to get some lean proteins.

Those might be animal based, right?

They might be chicken, very lean beef, seafood.

You could also do eggs.

You could also do dairy foods and then a little bit of healthy fats, right?

That's going to come from some of those nuts and seeds.

Also olive oils, avocado oils, things like that.

Those to me are the basics.

And that's generally how I try to structure my diet in the meals that I eat.

But again, the specific, the specific quantities and ratio of those foods and macronutrient groups to each other can look really different person to person.

Right.

And again, that's some of my, my concern with these, my plate and my pyramid that they're very generalized.

But we do know everybody's different, right?

And I want people to feel like if their plate doesn't quite look like what's recommended by, you know, the my plate, that's okay.

If it works for you and you're thriving with that and feeling good and managing your health and preventing disease with, with the way you have your plate structured, then that works for you.

And that's okay.

So I think we also have to remember that we have our own internal wisdom about what, what is good for us to.

>> You are in a unique position in that you're reaching a lot of people and talking to people at the same time.

Are we doing a good job of talking about what foods people should and or could eat, or have we just muddled the whole conversation?

>> She did a great job of explaining it on your show.

I was like, I should take some notes for myself.

>> But cookies?

More cookies.

That's the message.

>> That was definitely objectively what she was saying.

Yeah.

I mean, I think that there is a lot of good information out there about nutrition.

I do think she's right that it can get muddled when you're, you know, just bombarded with you're bombarded with all these different things at the grocery store and you're looking at, I mean, I'm looking at nutrition labels.

I, she gave me the approval to just put it back.

If I don't know what the ingredients are, which is better than me just furiously searching online, like, what even is that?

Yeah.

But I mean, I think that there is great information out there, but I do think it can be overwhelming when we're looking at each individual piece of food that you might be thinking about eating.

So I feel like I liked her message, which I think is a strong one of like that.

It's actually simpler then than you think, you know, like, like here's like sort of try to remember these basic, simple kind of facts of like what goes into a well balanced diet and know that that's not going to change and kind of see if what you're looking at eating kind of fits in any of those buckets or not.

And if so, how strong is the inherent value of eating that cookie today?

Yeah, probably pretty strong.

>> But you know, we.

>> Hear a term, if you could tell me what it means to you, but food desert.

And as we tell people, okay, we want you to eat this stuff that you can pronounce, but in some food, these areas.

Is it always possible to do that?

>> I mean, that is that is the struggle, right?

Like with food deserts, it's sort of this term that's been used and become pretty popular to describe areas where access to affordable, fresh, often fresh foods is limited or, you know, basically nil.

You'll have that if there's, you know, not a grocery store within reasonable walking or driving distance, especially when you think about the fact that not everyone has access to a car.

And so that is tough, right?

I mean, if you're, if you've got a convenience store selling mostly, you know, some of those more processed foods or fast foods within a mile, but you have to drive ten or take the bus ten, you know, ten miles to go get to a grocery store.

Like, what are you going to do when you're also juggling all the other necessities of your life?

Although I do like what she pointed out, like not all processed food is bad, like a peanut jar of peanut butter that you pick it up at a convenience store is great.

But, but yeah, I mean, that is the struggle with food deserts is, you know, a lot of you see it with like the organic, like you slap an organic label on it and you're like, oh, that's more expensive than the other one, you know?

So I do think that's a big struggle and one that here in Kentucky and in Louisville, there's people trying to solve that in terms of how do you reduce some of those food deserts and give people fresh and affordable, healthy options.

>> As you're looking at what's going on in Frankfort with the Maha Kentucky Task force, do you think is that a right approach where government is starting to get involved with these food things that we're doing?

>> That's above my pay grade?

But, you know, it is interesting, like the Maha Task force, which they Republican led legislature started last year to kind of try to support President Trump and Health Secretary Robert F Kennedy Jr's, you know, movement.

They came out with suite of proposals after they met last year here in Kentucky.

And most of them have been getting like bipartisan overall.

They've been getting bipartisan buy in and stuff like, how can we get how can government pass some laws or make some policy changes to get healthier meals on offer in schools?

Should we have higher physical education requirements in high school?

Like pretty yeah, pretty bipartisan.

You know, I haven't seen a lot of pushback on that sort of sort of thing.

But the Maha move more generally has been controversial because they have pushed back against some things that are widely considered to be safe and effective.

But it does seem like, you know, food is sort of a broader discussion that people seem more open to engaging in.

>> I guess I'm.

>> Concerned with the last thing that Miss Mcniece was talking about, that we've put meat, red meat at the top of the pyramid, which don't get me wrong, I'm not a vegetarian, but there's a bunch of other things that need to be at the top.

Not sure.

>> Sure.

>> Talk to your nutritionist.

>> More cookies.

>> More cookies.

>> More cookies.

Okay, I.

>> Think that here in America.

>> Yeah.

>> Most of us probably can agree on.

>> No.

>> Please don't.

This is not Health Health advice.

>> We'll hold you on that one.

>> Let's shift gears a little bit.

I want to talk a little bit about Medicaid.

There has been much more conversation centered around Medicaid and its solvency, though both Medicaid and Medicare are federal programs, they serve different populations.

We asked Mr.

Bart Irwin, the CEO of Family Health Centers Portland, to give us some background.

>> Difference between Medicaid and about 50% of our patients are Medicaid patients, 20,000 a year and about 10% are Medicare.

Now, as you mentioned in the opening, Medicaid is a joint venture between the federal government and the state, and Medicare is a solely federal program that ensures persons who are 65 or older or some persons who are disabled.

Medicaid is really based upon income and family size.

>> Since Medicaid is a joint venture between the federal government and the states, this means that each has a vested financial interest.

Mr.

Irwin was able to shed a little light on this financial relationship.

>> Well, I say that that Medicaid for Kentucky is a great deal and an important deal as well.

Kentucky ranks fourth in regard to the amount of funds that the federal government provides for Medicaid services and for Kentucky for every dollar that the federal every Medicaid dollar the federal contribution is 79% and the Kentucky contribution is 21% or 27%.

Yeah, that.

So we receive a lot more funding from the federal government to afford Medicaid than do a lot of states.

And that's because we are a poor state.

>> For many reasons.

There have been discussions about cutting Medicaid funding.

While no one can be certain as to the impact of these potential changes, I asked Mr.

Irwin for his perspective as the CEO of a safety net provider.

>> Well, the federal government proposed to to cut $880 billion.

That's almost $1 trillion from Medicaid, a.

>> Trillion with a T.

>> A trillion with a T, just about $1 trillion over a period of ten years.

And I calculated how much that would mean to Kentucky.

It was like $880 million, something like that.

So there were several ways the federal government could have had that happen or make that happen.

They've really chosen a couple, and certainly they could.

They have not come said, well, we gave you $14 million in 24 from our federal resources to to do Medicaid, which they did.

I mean, $14 billion.

>> Billion dollars.

Okay.

>> Yeah, it's an expensive program.

We'll give you 12 this year.

That's not what they did.

There were a couple of things.

And one, it doesn't affect family health centers, but it does affect providers in the community like hospitals and nursing homes.

And that's a reduction in the provider tax.

And as I understand it, the hospitals like UofL Health pay a tax to participate in Medicaid.

And this tax goes to the state, and the state uses that money to match the federal amount that is provided.

So that 21% or 27% that Kentucky has to pay.

That's how they match it.

>> That's how.

>> They get.

So the federal government said, we're going to reduce the percent of tax.

You can charge the hospitals or the nursing homes or other care facilities.

We're going to reduce that.

And so there won't be as much of that money flowing to Frankfort to match the federal amount.

The match goes down on Kentucky's part.

The match goes down on the federal part as well.

So the federal government saves money because they're not sending the state as much.

>> One most qualified to be eligible to receive Medicaid.

And one of the qualifications is to be either just above, at, or below the federal poverty level.

There are other criteria that must also be met.

One of these, a requirement tied into some other state, a tried in some other states is a work requirement.

I asked Mr.

Irwin to explain how this works.

>> The breakdown of Medicaid recipients.

This is how it's broken down.

64% of the Medicaid recipients are working either part time or full time.

44% are working full time, 12% are caring for either a child who's ill or an aged person who's ill, who's disabled.

12%.

>> Yeah.

>> 10% are persons who are declared disabled.

So that's 10% of the Medicaid population.

7% of the Medicaid population are students, not not children, but students in college.

And so there that's 7% of them have and then 7% are persons who are retired or are looking for work.

That's 7% is the focus of the Medicaid work requirements.

Seven and for Kentucky, that's about 75,000 people.

It's my calculation.

So this program will directly affect 75,000 people.

They will have to 80 hours a month, 20 hours a week or so, will have to work or be in a training program or being in an education.

The state of Kentucky has been pretty generous with this.

Or you have to volunteer somewhere.

>> You know, it's clear that there may be a limited pie of money.

But I'm wondering, though, as we look at cutting back on funding to those who are in need, whether or not we're going to cause other problems down the road in terms of people having access to getting into health care, how do you see the long term effects of some of the changes that are being proposed for Medicaid funding?

>> Well, sure.

I mean, if people, as is expected, like a lot of people lose their Medicaid coverage because of the changes that are being made federally with these cuts and the work requirements, those people are going to not have health insurance.

And presumably, if they're on Medicaid, they're not able to go get, you know, commercial insurance.

So you're going to have what we had before Medicaid expansion, right?

Like a higher, you're going to see an increase in the percentage of uninsured people that has a lot of effects.

I mean, obviously, like no more the biggest effect being on that person, like who doesn't have health coverage anymore.

And then maybe they don't go in for a routine checkup with a doctor.

If they're worried, if they worried they can't afford it or, you know, they can't, they end up in medical debt due to, you know, different issues.

Like you definitely like that's a big thing.

And I think in a discussion that you have, right, that you see them having is that, you know, having a higher percentage of insured people with health insurance, you get healthier generally, like if you have access to health insurance, like you have better access to health care.

So you're going to have more people that are healthy and that's good for the economy, right?

Like you have, you know, a. Healthier population is like good societally, right?

In general.

So I think that's definitely a big concern.

I know that for hospitals, there's a concern about, you know, whether the Medicaid cuts means that they are going to be hit hard financially, like because a lot of hospitals can rely pretty significantly on the payments they get for taking care of people that have Medicaid insurance.

So it can be a pretty big financial hit.

I know that there's been some research about the potential for hospitals closing if based on the Medicaid cuts, both in Kentucky rural parts of Kentucky and in other states.

And then that means that people that live there, your hospital closes or, you know, has to roll back the what it's able to offer because of budget cuts.

And then you have to drive further to get to healthcare.

That used to be, you know, in your backyard.

>> So sounds like we're going to see if some of the changes go through as proposed.

Rural areas are probably going to be hit more so than some of the urban areas, or the impact of it is going to be greater.

>> I'm not sure I haven't like I think everyone's going to be impacted urban and rural.

But yes, like I have there has been like different estimates that have been released nationally and in Kentucky about the fact that this is going to hit rural areas hard oftentimes, like, I mean, Appalachian, Kentucky, right?

You have a lot of low income people there who a lot of whom like do qualify for Medicaid.

And so the potential of losing that coverage or having Medicaid cuts like you have, like Medicaid is a really big deal in those communities and losing that will have kind of ripple effects.

>> As you're out in the community and talking to people.

How much of a concern is this?

Or is this something that people aren't worried about?

Or if you ask somebody about how they feel about Medicaid having it or not having it, do they express an opinion?

>> I don't know, like I think it's Medicaid is like really hard.

Sometimes.

I have a hard time understanding all the ins and outs and of it.

So I think.

>> Welcome to the club.

Right?

>> Genuinely.

Right.

So I think sometimes, like if I ask someone like about how they feel about the changes that were made in the new federal law from last year, they may not necessarily know all the ins and outs of that, but if you talk to people in general about do they want to still have do they want to keep their health insurance?

Like most of the time when I talk to these people, they're all like, yes, I would, I would like to keep my health insurance.

I would like my, you know, to be able to afford health insurance to cover my health care.

Like that's a pretty universal perspective, at least in my experience and in a lot of, you know, other.

>> So how do you.

>> How do you, in your trying to explain to your audience, how do you try to break it down and say, this is what's happening?

>> It's like something I've learned is like, you have to like, it takes a lot of research on my part or my colleague's part, my fellow reporters part to try to understand the ins and outs of the changes being proposed so that you could write it really complicatedly, so that then you have to like, understand all the complexities to be able to try to then break it down into the simplest thing.

Like we think the federal government's going to cut Medicaid by X amount.

Best estimates are.

That means that this many as, as your guest was talking about like this, many people are going to be subject to work requirements.

And if they don't file their paperwork properly and meet the requirements and don't miss file anything, then they could lose their coverage.

And so it's like trying to break it down to the simplest piece, because people honestly just don't have time for all the complex.

It's like, I want to give you the bullet points that you need to know to know.

Like, what does this mean for Medicaid and for your local hospitals?

>> You have your eye on this.

>> Yeah, but not as much as some of my, my friends have.

It's a, it's a, it's a, it's a team effort.

>> It is.

>> Cover.

>> I tell you.

But just in terms of its overall impact, I think, I think a lot of us are going to be paying.

>> Oh yeah.

>> Like scrutiny.

>> On this one.

>> Yes.

I think as you see the changes being decided.

And what is this actually look like?

Yeah.

Myself, journalists, health care providers, hospital, you know, people running hospitals, everyone's paying attention.

>> Well, Morgan, thank you very much for being with me on this review.

I hope it hasn't been too odious for you.

I enjoyed hearing I've enjoyed having it.

And thank you for being with us.

If you wish to watch this show again or watch an archived version of past shows, please go to WW ket.org.

If you have a question or comment about this or other shows, we can be reached at KY.

Health at ket.org.

I look forward to seeing you in the next Kentucky Health.

But in the meantime, if you happen to listen to the radio and you want to listen to Morgan Watkins, go right ahead.

Otherwise, we look forward to seeing you when you get some really good health news here with us.

Take care of yourself.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.