OPINION
DOCTORS' Lounge
associated with decreased cardiovascular
risk.” The Swedes took this as a challenge
and studied it better.
Mubanga et al. in the 11/17/17 Scientif-
ic Reports published a prospective 12-year
cohort study, based on the 34,000 people
listed in the Swedish Twin Register, part of
an overall cohort of 3.4 million people in
the Swedish National Register. They found
that dog ownership by those who live alone
was associated with a lower risk of both
death (hazard ratio 0.67 compared to the
norm, 1.0) and specific cardiovascular death
(hazard ratio 0.64). Single owners of hunt-
ing dog breeds had the lowest risk. Those
who lived with partners/family had ratios of
0.85/0.8 compared to non-dog owners. All
dogs in Sweden have a unique national ID
number as well, so the authors could track
their lives too.
The authors echo other studies which
show that dog owners walk more, and also
keep up their outdoor exercise despite bad
weather. Dog owners’ blood pressures have
been shown to drop when in contact with
their pets, and they are less socially isolated.
Dog owners who have heart attacks have
been found to have improved survival. Dogs
have been credited with improving their
owners’ blood sugars as well. GRRAND.org. One can also call a toll free
number, 1 866 981 2251; volunteers man the
phones and they will return your message
when they are able. They need volunteers
for all kinds of things – dog transports,
helping with veterinarian details, etc. Ex-
perienced dog-walkers are always welcome,
but many other skills are needed. As I write
this, there are goldens and labradoodles
ready for adoption.
Of note, we both walk at least 40 min-
utes more a day than before (separately, to
increase his exercise). I cannot say that we
eat more carrots, but he does. I can say that
the advice from our friends is that the cats
will ultimately rule the roost, and watching
this drama play out is fascinating. Remember, it could be good for your
heart. I promise it will be good for your
psyche. We are just rejoicing daily that we
took a Chance.
If you are in need of a golden retriever,
or would like to help others find one, check
out www.GRRAND.org or email info@
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
A NEW PROVIDER TAX ON KENTUCKY
PHYSICIANS: How Corrosive to Health Care for the
Underserved Will it Be?
T
Gordon R. Tobin, MD
he 2019 Kentucky legislative ses-
sion will likely consider legislation
to tax collections on physician ser-
vices. Such a proposal was raised
in an August 2018 press con-
ference by a group of hospital executives,
who unveiled a new organization, Balanced
Health Kentucky, Inc., that advocates re-
structuring Medicaid-supporting taxes on
providers to cover increased State funding
responsibilities for expanded Medicaid.
The organization’s website, Balanced-
HealthKY.com, warrants examination. It
reveals the rationale for their proposal, ini-
tial news coverage, legislative contacts and
talking points. It also lists current Kentucky
provider groups paying taxes for tradition-
al Medicaid, potential sources (including
physicians) for new revenue, and the ben-
efits of Expanded Medicaid to Kentucky.
The website echoes concern that expanded
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LOUISVILLE MEDICINE
Medicaid could be fully rescinded if the
State’s component is not funded, thus losing
federal matching funds. There is a strong
argument for maintaining Kentucky’s par-
ticipation in the program, considering the
current federal match is $9 for every $1
the State contributes. BalancedHealthKY’s
website expresses an opinion that the state
component of this funding should come
from within Kentucky’s healthcare economy,
rather than other sources, but it leaves the
distribution between provider categories to
be taxed up to the legislature.
To better understand this initiative, one
needs to review the role of provider taxes
in traditional (pre-Affordable Care Act)
Medicaid, and their potential role in fund-
ing expanded Medicaid of the Affordable
Care Act.
Traditional Medicaid and the Funding
Role of Existing Provider Taxes
The concept of taxing providers for funding
traditional Medicaid was introduced in the
1980’s, and it became widely adopted in
the mid-1990’s, with 49 of 50 states (Alaska
excluded) now participating. Substantial
controversy and litigation resulted from the
initiatives. As a result, such taxation poten-
tially applies to 19 categories of health care
providers, including institutions (e.g. hospi-
tals, nursing homes, managed care organiza-
tions, etc.) and individual professionals (e.g.
physicians, dentists, mental health workers,
etc.). The revenue generated is returned with
federal matching funds (up to 300 percent)
to enhance Medicaid payments.
Within these 19 categories, there were
differing net effects, which led to differing
positions among them. Individual providers
largely experienced net losses that could not
be passed on to insurers and policy payers.
Thus, most physicians and their organiza-