Under the Affordable Care Act, health insurance coverage increased. Between 2010 and 2015, the uninsured rate among women ages 18 to 64 decreased from 19.3 percent to 10.8 percent, a relative reduction of 44 percent.

As of 2016, national enrollment in Medicaid has grown to 75.2 million from 57.7 million in 2013, or total growth of 17.6 million (31%). Nine states have posted over 50% growth, with Nevada just shy of doubling at 97%, Colorado 89%, Montana 82%, Kentucky 73%, and California up 71%.

https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf

Medicaid is the nation’s largest insurer. It is the centerpiece of the U.S. health care safety net, providing benefits to adults and children who would otherwise have difficulty getting and paying for care. Yet the program is not well understood by the public

• Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured
• Most people are satisfied with their Medicaid coverage. A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent (Exhibit 2). These ratings have remained consistent since 2014, when states began expanding their programs
• Medicaid helps people get care and improve their health.
• Medicaid provides access to timely care.
• Medicaid provides comprehensive benefits and financial protection from large medical bills.

http://www.commonwealthfund.org/publications/blog/2016/dec/~/media/5b2abe91c9b74cec8b4a24c90ea6826b.ashx

Did you know?

A “block grant” is a fixed amount of money that the federal government gives to a state for a specific purpose.

The Republicans propose that the Federal Government would fund Medicaid as a block grant. Counter to what proponents claim, block grants don’t give states more flexibility with their Medicaid programs.

What does this mean for state Medicaid expansion?

The federal government would set each state’s Medicaid spending amount in advance. That amount would be based on some estimate of state Medicaid spending.  This would mean a significant cut in federal Medicaid support and an increase in state funding.  Most states would meet this need by limiting eligibility.

http://www.cbpp.org/blog/medicaid-block-grant-would-add-millions-to-uninsured-and-underinsured

Overall, hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor

http://kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health/

Looking back 2016 was a year of celebrating but also a year of disappointment. The year started with spending time with my best friend from medical school and her husband in Oakland, CA. I took this trip to regroup after leaving my position as a medical director at a major university to resume teaching in a family medicine residency program. My friend is always so open and honest. She keeps me grounded because she always tells me the truth. That is important because I can be hard on me. I spent three months reacquainting myself with hospital inpatient medicine. It was a really exciting period which I enjoyed. Getting back into prenatal care in my new position as the Women’s Health Coordinator for the residency program was the most enjoyable.

In May, I attended the annual Society of Teachers of Family Medicine Meeting in Minneapolis Minnesota. I accepted a position as a trustee on the STFM Foundation Board. My husband got the chance to explore Minneapolis. The meeting was highlighted by the keynote speakers. The first was Camara Phyllis Jones, MD, MPH, PhD from the Satcher Health Leadership Institute and the Cardiovascular Research Institute the topic was “Achieving Health Equity: Tools for a National Campaign Against Racism.” She presented several tools for dealing with racism: https://www.youtube.com/watch?v=3aXoBfmSBNQ

June was a spectacular month. We attended our family reunion in Savannah Georgia. It was attended by members of my grandmother’s family.   We had an opportunity to tour Savannah and learn about the impact of slavery in the shaping of the history Savannah and the south. During this time we were in the midst of the most divisive presidential campaign in history.

In September we went to DC for the opening of the National Museum of African-American History and Culture. The weather in DC was beautiful and we walked all over the place. We did not have tickets to tour the museum but we went to all the festivities. We sat out on the National Mall with the crowds watching the ceremony on one of the many jumbo Trons. We all shed tears after each speaker. Patti Labelle sang “A Change is Gonna Come” and there was not a dry eye. Former President George Bush and his wife Laura Bush were instrumental in getting the bill signed and serving on the board for the museum. The Obamas continued their work. In the words of Lonnie G. Bunch III, founding director of the Museum, “there are few things as powerful and as important as a people, as a nation that is steeped in its history.”

We spent election at a friend’s. The party was not the celebration we had hoped for. The last time she had an election night party was when Bill Clinton won. I was in Maryland and that was the last time I attended one. It was a heart breaking night. We all were in shock. The next day, I spent the day consoling my residents. I am still coming to terms with my disappointment over Hillary Clinton’s loss. She would have been the first female president of the US and could have joined Angela Merkel and Teresa May.

In December, we spent a week in Ocean City Maryland. The weather was beautiful. I needed the change.

I completed my a 200 hour yoga teacher certification program at The American Yoga Academy .  I am certified as a Health and Wellness Educator.

We spent Christmas Day in Baltimore with family. We spent the day visiting family. With Christmas falling on the Sunday, we both had Monday off. We have celebrated 33 New Year’s Eves together.  We spent a quiet evening at home and watched “Casablanca”

Here’s to 2017.   I am going to work very hard the first few months because of projects I need to complete but I do plan to spend time catching up with old friends. I do not make resolutions but if I chose a theme or a word, it would be “Gratitude.”  I am thankful for who I am and what I have which includes friends, family and work that I enjoy. As we celebrate MLK Day and anxiously await the peaceful passage of power from the first black President of the US, Barack Obama, to Donald Trump, I am thankful that the Constitution of the United States has checks and balances. I am hopeful for our future. As a physician, I am confident that the Affordable Care Act will not be repealed because it will have disastrous consequences.

I made Gumbo New Year’s Eve. The first time I made it was while we were living on the Eastern Shore.  I had what I thought was a great recipe in a cookbook titled “One of a Kind: Recipes from the Junior League of Mobile.”  It was a wedding gift.  I was making the Gumbo for our Mardi Gras Party at a colleague’s house. A group of us decided to bring Mardi Gras to us. Being the only true southerner, I volunteered to make the Gumbo.

I took my cookbook to my husband’s aunt, Tommie.  She was a New Orleans native and true Cajun (her father was from Paris and her mother, African American). She was known for her Gumbo recipe which she guarded like a state secret.  She took the book and crossed out (with great emotion) some of listed the ingredients and added no new ones.  I did not know that really good gumbo is simple.  She did not use crab meat, chicken or the gumbo file. It’s just good Andouille sausage and lots of shrimp.  The secret is the roux and the cooking time.  The best okra is frozen and do not cook it long.  Add the shrimp and do not overcook.  It only takes a few minutes if the gumbo is hot.

We always purchased the shrimp in Baltimore at Lexington Market for years.  That meant, we always had an ice chest in the trunk and we have transported shrimp as far as Chattanooga, Tennessee.  I always tried to get the sausage there too.  One year, we almost did not find the sausage.   Well the Gumbo was the hit of that party and many more.  Over the years I have made it so many times and it never fails to impress. I have had to toss out a couple of bad batches of roux.

What is unfortunate is that our beloved aunt has Alzheimer’s.  I always made sure we talked for hours when we visited her in Baltimore. So I know a great deal of family secrets.  She lived two row houses down from my mother-in law.  The two of them were more like sisters than sister-in-laws. My mother-in-law passed first.  Tommie was heart-broken. We cleared the house together. When she started showing signs of memory loss and became more difficult to manage: Roy and I would visit, take her to lunch at her favorite place, the “Cheese Cake Factory, and then to church.  We also would take her to the mall and to visit friends and relatives.  Roy had a calming effect on her.  He would drive and talk to her.  She had taken care of him when his mother was working. He always made her laugh.

I made the Gumbo a few years before we lost Tommie’s husband. It was the year Christmas Eve was on a Friday. When I told them I was making it, they all reminisced about Tommie’s Gumbo and told such sweet stories. Well, when I told them I was using her recipe they were in disbelief. They asked how I had been so lucky and I told them. That was a special pot of Gumbo and I was so proud to make it. It was downed with love. We had leftovers for Christmas dinner. They all said it was indeed her recipe. It was also the year after we lost our great hostess, Sylvia. She was the wife of Tommie’s son Jack. Jack is like my husband’s baby brother. Sylvia was the one who put together all the holiday dinners. So that pot of Gumbo was in honor of two great ladies.

I can’t help but speak of Tommie in the past tense.  That is what Alzheimer’s does.  It robs you of the person and leaves just the body. The woman I knew is not here but I did take her to lunch right before she had a turn for the worse. We had a great time.  We may have even gone to church.  She would have been wearing a mink stole or her Persian lamb jacket and I would have been wearing Josephine’s coat (also Persian lamb). Both of the coats are over 50 years old.

New Year’s is a time of reflection.  My New Year’s commitment is to catchup with old friends and colleagues. I want to put the past year behind me. I do plan to stay vigilant but that is for the next post.

Happy New Year!