Kentucky improved its standing in many health measures in recent years but still ranks near the bottom nationally, in part because of a troubling increase in deaths from suicide, alcohol abuse and drug overdoses, according to a report released Thursday.
The state's rate in those "deaths of despair" was 48.9 people per 100,000 residents in 2013, but surged to 61.7 per 100,000 in 2016, according to the report from The Commonwealth Fund.
Kentucky’s 2016 rate was substantially higher than the national average of 43.2 deaths per 100,000.
The report said that the combined rate of deaths from suicide and use of alcohol and drugs went up 50 percent nationally from 2005 to 2016, the last year with full statistics available.
Kentucky has seen spikes in recent years in abuse of heroin and a more powerful drug called fentanyl, in addition to continued abuse of prescription painkillers, such as oxycodone.
The overdose death rate has been particularly high in the state's Appalachian region.
The state had a record 1,404 drug overdose deaths in 2016. The total for 2017 has not yet been released, but authorities do not expect it to go down.
The rise in deaths of despair was a key factor in a decline in average life expectancy in the nation in 2016, the report said.
The Centers for Disease Control and Prevention reported that U.S. life expectancy at birth went down in 2016 by one-tenth of a year – to 78.6 — following a similar drop in 2015, according to a commentary by David Blumenthal, a physician who is president of The Commonwealth Fund.
It was the first time in 50 years that life expectancy went down two years in a row, Blumenthal said.
The Commonwealth Fund says it is a private foundation with a goal to promote better access to health care, improved quality, and greater efficiency, especially for low-income people and others considered vulnerable.
It funds research on health care.
The report issued Thursday, called the 2018 Scorecard on State Health System Performance, assessed all states and the District of Columbia on more than 40 measures of health care access, quality of care and other factors.
The researchers said that overall, there was more improvement than decline on health measures the last few years.
In one key metric, the number of adults without insurance went down in 47 states between 2013 and 2016, the report said. States that expanded Medicaid coverage under the federal Affordable Care Act, commonly called Obamacare, recorded bigger drops in the number of uninsured residents, the report said.
Kentucky was one of those.
The number of Kentucky adults without insurance dropped from 21 percent in 2013 to 7 percent in 2016 as hundreds of thousands of people received coverage under Medicaid, the report said. However, the state may reverse some of that improvement.
The Affordable Care Act has been one of the most controversial laws in recent U.S. history, of course, with advocates arguing it has improved the lives of millions who otherwise couldn’t afford health care and critics saying it has helped drive up insurance costs and reduced choices of plans.
Gov. Matt Bevin and others have said Kentucky’s Medicaid expansion is financially unsustainable. Bevin’s administration received approval under President Donald Trump for a waiver requiring able-bodied adult Medicaid participants to complete 80 hours a month of work, education, job training or community service to keep benefits.
Another provision of the waiver, which has not yet taken effect, is for Medicaid beneficiaries to pay premiums of $1 to $15 a month at first.
Critics say the provisions would be difficult for many Medicaid participants to meet and that many would lose coverage as a result.
Bevin’s administration estimated that 95,000 Medicaid participants will lose their coverage over the next five years, out of more than 400,000 Kentuckians just above the poverty line who are currently enrolled in the expanded program.
The Commonwealth Fund scorecard also reported improvements in every state in the number of home-health patients whose mobility increased — the percentage in Kentucky who didn’t get better dropped from 36 percent in 2013 to 25 percent in 2016. Moreover, there is a lower percentage of nursing-home patients receiving potentially harmful antipsychotic drugs.
Tobacco use continued down by at least 3 percentage points in all but four states, the report said. Kentucky was one of the four. The number of adults who smoke decreased 1 percent.
The report ranked Kentucky at 42 overall in health care performance, up from 46 in the baseline ranking.
Hawaii, Massachusetts, Minnesota, Vermont, and Utah had the best overall rankings, while Louisiana, Oklahoma, and Mississippi finished at the bottom.
The report found "pervasive" gaps in mental health care in the nation – with up to a quarter of adults with mental illness reporting an unmet need for care — and said obesity continues to represent a rising public health threat.
The percentage of adult Kentuckians considered obese went up from 34 in 2013 to 35 in 2016, the report said.
Mississippi and West Virginia had the highest levels of obese adults, at 39 percent each, but no state was lower than 22 percent.