The [Medicaid] expansion could help extend insurance in some of the state’s poorer counties, such as Greene and Wilcox counties, where median household income runs between $22,000 and $23,000 a year. However, Williamson said, 60 of the state’s 67 counties lack health care providers. “The problem is if you’re expanding by 40 percent the Medicaid population, you are not expanding by 40 percent the provider population,” he said. “I don’t think you can say giving 400,000 people a Medicaid card is going to be equivalent of giving them access.”

Dr Don Williamson, State Health Officer and interim Alabama Medicaid Commisioner, on whether or not to accept the Medicaid expansion included in ObamaCare.

Hillsdale Middle School,which was in a rough, somewhat working class neighborhood, was torn down in Mobile this past year. It was built in the mid-1960s. I used to take the 1st year medical students to  the school in the spring to deliver health information to the students and faculty. It was their first contact with real people as a health professional and they tended to be very excited. They would put together information and use games and other means of interacting with the students. For the most part it offered the medical students a window into care delivery and offered the middle school students an opportunity to obtain free, unbiased health information.

After the second or third time, the principal took me to the flag area to show me a plaque. It read “Hillsdale High School, built to serve colored Mobile students, 1965.” He explained to me that the school, built without the bells and whistles which usually accompany high school construction, was built to try to provide a solution to the “separate but equal” problem. Of course, 1965 is ten years after the “Brown vs the Board of Education” ruling that separate but equal was ineffective.  Four years later, when Phidippides arrived in Mobile with the news that segregated education was against the law, it was converted into an integrated middle school.

The evidence for a primary care solution to the health care access problem has been known for many years. The commercial insurance market has felt the pressure since the founding of the Patient Centered Primary Care Collaborative by large employers in 2006. We had evidence in Mobile for the need for better, more improved Medicaid delivery in 2000 with the failure of the Bay Health Medicaid HMO. North Carolina has shown how to do it right with CCNC.

Unfortunately, rather than thoughtfully working through how to best deliver the best care (which is primary care) to the citizens of Alabama, we have this response instead, from Alabama State Senator Paul Bussman, R Cullman:

Bussman said he hopes voters will defeat President Obama in his reelection bid and pressure Congress to strike down the health care plan.

“We already have an issue in Alabama with a shortage of physicians. This will overrun those that we have,” Bussman said. “I personally hope this becomes like a Pearl Harbor and the American people say they’ve had enough. The only way to repeal this is to get (President Obama) out of office.”

So…a little advice. Black folks and white folks are together in school and the world did not end. Fight all you want, the Affordable Care Act is the law of the land. If I were you, Alabama Legislature, I would direct Dr Williamson to figure out creative ways to provide care to all of your constituents as access will no longer be limited by income.