Study Shows Need for Benefits in Kentucky, Where They May Wither

The study suggests treating depression could help combating poor diet and obesity. But in Kentucky, the future of Medicaid expansion is in doubt following the recent election.

The poster didn’t get much attention at the American Heart Association, which held its Scientific Sessions in Orlando, Florida, last week. But against the backdrop of what is going on with healthcare in Kentucky, its findings are significant.

Researchers studied the connection between depressive symptoms and the quality of diets among rural Kentucky residents who were overweight or obese, to see if one affected the other. What they found was interesting: while both those who were obese (with a body mass index at least 30) and those who were overweight (BMI between 25 and 29.9) showed signs of depression, they were higher in those already obese.

However, depressive symptoms were a greater predictor of poor diet quality in those overweight but not yet obese. It suggests that if depression could be treated, and arrested, perhaps dietary habits would improve before the person gains enough weight to become obese.

Roughly 500,000 Kentuckians have recently obtained insurance through the Affordable Care Act (ACA), including 425,000 who gained coverage through Medicaid expansion. Because the ACA specifically requires that mental health coverage be included as an essential health benefit, many poor Americans have access to benefits to treat depression or substance abuse disorder for the first time. These problems are acute in rural areas—the state of Kentucky has sued the maker of OxyContin over the costs of caring for residents who have become addicted to the painkiller.

The abstract at AHA didn’t list the participants’ insurance status. However, they lived in rural Kentucky where rates of smoking and cardiovascular disease are high. Most were women (73%) and their average age (53 ± 15) shows that most of the study population was too young for Medicare.

The future of Medicaid expansion is unclear, because 2 weeks ago Kentucky elected Republican Matt Bevin as its next governor; Democrat Steve Beshear faced term limits. Bevin has called for ending Kentucky’s state-level exchange, Kynect, which Beshear says helps consumers sign up for coverage—many residents do not even realize the health insurance is part of “Obamacare.”

Bevin also wants to change the terms of Medicaid for those who gained it under expansion, adding copays or cost-sharing so that beneficiaries have “skin in the game.” How much he will add is unclear, but he has cited Indiana’s plan as a model.

Ironically, an analysis by the Lexington Herald Leader found that the counties with the greatest penetration of Medicaid expansion showed the strongest support for Bevin. While these countries include large numbers of working poor, they vote based on social issues. Voters told the news outlet they were motivated this year by resistance to gay marriage and the “Black Lives Matter” movement.

Since Medicaid expansion, rural clinics have been able to add services such as optometry and dentistry, and the patients showing up who had been going without care were very sick.

“During the past 2 years, we’ve been able to take some positive steps,” Mike Caudill, chief executive officer of the nonprofit Mountain Comprehensive Health Corp. told the Herald Leader. “I don’t want us to lose that.”


Abshire DA, Lennie TA, Chung ML, Biddle MJ, Moser DK. Obesity moderates the relationship between depressive symptoms and diet quality in overweight and obese adults in rural Kentucky. Presented at the American Heart Association Scientific Sessions; Orlando, Florida; November 10, 2015; abstract T-2036.

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