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How to Grow Your Own Herbs for Cooking

The next time a recipe calls for fresh basil, skip the poor substitute of dried basil, forgo the last-minute dash to the supermarket for some overpriced wilted basil, and just pluck a few tender leaves off of the basil plant you have growing in your very own herb garden.  What? You don't have fresh basil growing in your garden? Well consider this your invitation to start. Growing your own herbs is a simple and inexpensive undertaking that pays off big for your taste buds and your budget.  If you can keep a houseplant alive, you can sustain an herb garden.  Here’s how. Decide what you want to grow.  Some popular choices from home cooks are listed here along with their care instructions.  Start with just a few that you know you’ll use regularly, and then branch out from there. Herb Special Care How to Harvest How to Use Basil Pinch off any flowers that appear. This preserves the plant’s flavor, and will also help increase the leaf density of each stem. Harvest the upper leaves first, taking just a few leaves from each stem at a time. Add raw to salads, sandwiches and wraps, cook into soups and sauces, chop and sprinkle on pizza, make pesto. Parsley Parsley has a longer than average germination period of three to four weeks, so extra patience is required. Cut the outermost stalks just above ground level, which will encourage further growth. Both the leaves and stalks can be eaten in salads, soups, and Mediterranean dishes like Tabouli. Chives If you don’t intend on eating the flowers, pinch them off as soon as they begin to appear. Cut the leaves with scissors, starting with the outside leaves first, allowing about 2 inches of the leaves to remain. This entire plant can be eaten from top to bottom— the bulbs taste like mild onions, the leaves can be used in salads and other dishes, and even the flower heads can be tossed into salads. Cilantro Cilantro does not like hot weather. If the soil temperature reaches 75 degrees, the plant will bolt and go to seed, making this a short-lived herb. Aggressive pruning will extend its life, so be ready to use or store it. Save the seeds to use in cooking (the seeds are called coriander) or to plant. There are two methods of harvesting cilantro. When the plant reaches about 6" in height, you can remove the outer leaves with a scissors, leaving the growing point intact for new growth. Or you can wait until the plant is almost completely grown and pull it from the soil by its roots to use the whole bunch at once. Salads, wraps, dips, and many Mexican recipes. Rosemary This plant can be difficult to start from seed, so you may wish to buy a mature plant. And be careful not to overwater—rosemary likes its soil on the dry side. Simply cut off pieces of the stem as you need it. Many culinary and even medicinal uses. Thyme This plant can take awhile to start from seed, so you may wish to buy a mature plant. Drought-tolerant thyme is extremely easy to care for, and prefers drier soils. Simply cut off pieces of the stem as you need it. Often used to flavor meats, soups, and stews. Dill Drought-tolerant dill is extremely easy to care for, and prefers drier soils. Don't start harvesting dill until it's at least 12 inches tall, and never take more than one-third of the leaves at any one time. Great flavoring for fish, lamb, potatoes, and peas. Mint Mint is an invasive plant so stick to container gardening with this one. Pinch off sprigs as you need them. Mint is extremely versatile, and can be used in salads, desserts, drinks, and many other recipes. You can even chew it by itself for a pleasant, refreshing flavor.   Decide where to plant your herbs. Many herbs grow well indoors and outdoors in the ground or in containers.  If you have a little space with at least 5 hours of direct sunlight a day, you may prefer to grow them indoors, as the herbs will be much more accessible for cooking and watering, and not subject to threats of pests, weeds, or variations in temperature. Decide whether you’ll start from seeds or seedlings.  Seedlings are very young plants that you can transplant into your own garden. They are typically only available in the spring and summer from gardening centers and farmers markets.  Seeds cost less, but take more time and resources to grow from scratch (here's how). Gather your materials.  You’ll need a few gardening tools, like a small shovel or spade, some gardening gloves and pots or containers (optional since herbs can also be planted directly into the soil). You’ll also need some fertilized soil.  If you have a compost pile, you can use some fully decomposed compost to fertilize the soil.  Otherwise, you can use a general purpose compost solution, available in any gardening store.   If you’re container gardening, use a packaged potting soil mix, which will be free of pests. Start planting.  If you’re starting from seeds, sow into moist soil and cover with 1/2 inch of soil on top.  The seeds should germinate in about one week.  If you’re using a pot or container for seedlings, follow these steps.

  1. Ensure proper drainage by filling the pot with a shallow layer of course gravel.  
  2. Fill the pot about 1/2 of the way full, and place the plant, still in its original container, into the new pot.  Add dirt around the plant, gently packing it into place, so that the top of the new soil is at the same level as the top of the plant’s original soil.   
  3. Remove the plastic pot, tap it so you can easily slide the plant and all of its soil out, and place the plant and all of its soil into the hole in the soil of the new pot.
Care for your plants. Water at the base of the plant when the soil begins to feel dry, at least once per week.  Pull weeds that appear near the plant, because they will steal the nutrients from the soil.  If growing outdoors, bring them in before the first frost. Harvest the herbs.  Most plants will grow new leaves if you don’t pick the stems bare. You can pick the leaves with your fingers or snip them with kitchen shears. Use or store the herbs.  Many recipes call for fresh herbs, so simply pick your herbs, wash them and pat them dry before using in your favorite recipes. To store, you can preserve your herbs for future use by freezing them or drying them.  In either case, you must first prep them.  First, remove any soil or bugs by rinsing in cold water.  Then, remove flowering stems and flowers and gently remove excess water by patting with a paper towel.  Once your herbs are prepped, you can choose your method of storage:
  • Air drying:  Cut the stems at soil level and hang upside down in bunches (so that the flavorful oil travels into the leaves) to dry for one to two weeks.  Once dry, remove the leaves from the stems and store in a dry, airtight container for up to a year.  
  • Freezing:  The benefit of freezing, as opposed to drying, is that the herbs retain more of their just-picked flavor.  Place clean herbs directly into freezer bags, or try the cube method: Place a few teaspoons of chopped, fresh herbs into each cell of an ice cube tray.  Fill the trays with water, and freeze.  When cooking, just pop out a cube and add it to the pot like you would fresh herbs!
Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1739

How a 'Bad Food' Attitude Can Backfire

Do you struggle with cravings and wish you had the will power to cut out certain foods completely? When we work toward a healthy diet, so many of us think that making a list of food culprits and calling them off-limits will help us to succeed. However, if you take a deeper look at the psychology behind this flawed method, you’ll see so many reasons why adopting a ''good food'' or ''bad food'' attitude will never work.  Restricting certain foods won't just make dieting miserable--it can also ruin your good intentions of getting healthy and losing weight. Making arbitrary rules about good and bad food isn’t the answer to lasting lifestyle change. Instead, use the tips below to build a better relationship with food, learn to master cravings, build self-control and enjoy all foods in moderation.   Stop Labeling Foods as 'Good' and 'Bad' For decades, behavior analysts have studied the effects of deprivation on people’s preferences for food, tangible items and activities. The majority of literature on this topic says that, when we’re deprived of something, we’re more likely to select that particular item from an array of choices. In a recent study conducted at the University of Toronto at Mississauga, researchers found that participants who were asked to restrict either high-carb or high-protein foods for three days reported higher cravings for the banned foods. So, if you label chocolate as evil and forbid it from your menu, you’ll be more likely to want it in any form.   The good news is that some level of satiation (satisfying your craving for a particular food) can actually help you to avoid overindulging more often than not. If you can be conscious about your eating and have just enough of your favorite chocolate bar to satisfy that craving, you’ll be much less tempted to dip into the candy jar on your co-worker’s desk or buy a sweet snack from the vending machine.   This information about deprivation seems like common sense, but you’ve probably heard from friends or fellow dieters that the first step in avoiding high-calorie foods is putting them out of your mind altogether. Not true! Researchers are realizing that suppressing thoughts about a particular food can cause an increase in consumption of that food. In a 2010 study, 116 women were split into three groups. The first group was asked to suppress thoughts about chocolate, the second group was asked to actively think about chocolate, and the third group was instructed to think about anything they wished. Afterward, each of the participants was given a chocolate bar. The women who had suppressed their thoughts about chocolate ate significantly more chocolate than the others, despite identifying themselves as more ''restrained eaters'' in general. This just goes to show that ''out of mind'' doesn’t necessarily always mean ''out of mouth.''   Dump the Idea of 'Diet Foods' Often, when people are trying to eat better, they start to categorize foods into those that are on their diet plan and those that are not. However, banning specific foods from your weight-loss plan may just make you crave them more.  According to an article published this year in the journal Appetite, a UK study of 129 women measured the cravings of those who were ''dieting'' to lose weight, ''watching'' to maintain their weight, and not dieting at all. The researchers found that, compared with non-dieters, dieters experienced stronger, more irresistible cravings for the foods they were restricting.   Noticing the difference between healthy and unhealthy options is definitely key in establishing a pattern of better eating. And, when you’re starting a weight-loss program, it does help to read food labels and menus carefully so that you can choose wisely. However, when you start to categorize specific foods such as candy, baked goods, alcohol and fried chicken as foods you can’t have, you’re setting yourself up for a backfire. The issue with labeling a food as a forbidden substance is that your thoughts immediately center on that particular item... and then you inadvertently start bargaining and rationalizing to get more of it. (How many times have you broken your ''diet rules'' to reward a trip to the gym with chocolate or a long day at work with a cocktail or two?)   There are some diet plans out there that advocate choosing a particular day of the week as your ''cheat day''--a day when you can indulge in all the foods you’ve cut out during the week. But listing certain foods as ''cheats'' or ''treats'' can set up a scenario where you’re depriving yourself all week long and constantly looking to the future, waiting on the moment that you’ll be showered with your favorite forbidden goodies (like those commercials where fruit-flavored candies fall from a rainbow).   Besides causing you to crave, labeling certain foods as ''forbidden'' makes it really difficult to be mindful of and content with the healthy food you’re eating most of the time. Instead of worrying about restricting foods, try to redirect your focus on creating the most delicious salad, grilling a succulent chicken breast or munching a juicy piece of fruit. If you turn your attention to the abundance of healthy options in front of you instead of weighing the pros and cons of particular foods, you’ll be more likely to really relish and rejoice in your everyday choices.   Make Sense of 'Moderation' You’ve heard the line a thousand times: Everything in moderation. But what does this phrase really mean and how can you apply it to your healthy eating plan? Usually, people hand this advice out when they’re indulging in unhealthy food and drink and trying to get you to join in, say at a wedding or birthday party. So is it just peer pressure? Or is there something to this age-old saying?   Choosing to eat all foods in moderation works just fine for some people. If you have a healthy relationship with food (e.g., you have no trouble putting away the bag of chips after just one serving), then eating a little bit of your favorite food may satisfy your craving and leave you full until the next healthy meal.   However, for some people, it just doesn’t work that way. Sweets, salts and alcohol all cause biological reactions in the body that are hard to ignore. And, if you’re someone who responds strongly to these reactions, even one small bite can trigger you to continue sampling similar goodies. If you’re one of these folks, you’re definitely not alone, and it is important to know which foods affect you in these ways. Perhaps you’re a person who can have a bite of a sundae and pass the rest on to your spouse, but a fun-size candy bar can unravel your motivation and spark unhealthy choices for the rest of the day. Noting which tempting foods are your triggers can help you arrange your environment so that you don’t overindulge.   Rearranging your environment for success is the easiest way to change your behavior. If you do decide to indulge in a ''trigger food'' in moderation, opt to eat it in a place where there aren't any other snack options for you to munch on afterwards (a food-filled party would not be the best environment!). Choose snacks that you like, but don't love, so you're not tempted to eat too much but are still satisfied. Understanding which foods are likely to lead you down a slippery slope and preparing your environment and schedule for success will help you keep cravings at bay and keep your overeating under control.   Keep Cravings in Check Cravings are a good thing. On a basic, biological level, cravings tell us when we’re hungry, thirsty, sleepy and even when we need some human attention. The problem is that, because we’re so accustomed to having easy access to eat whenever we want and we’re able to choose from many unhealthy foods, the ratio of our wants and needs are all out of whack! It is time to step back and become aware of what we’re really craving and why. When we can look objectively at our yearnings for soda, chips, cake and cookies, we can make much better decisions about what we put in our mouths.   One of the best ways to get back in touch with your true cravings is to keep track of them.  For a few days, keep a journal of the time of day, what you’re craving, and whether you’re at work, at home, on the road, with your kids, etc. You can still give in to temptation—this exercise will simply give you a clearer picture of how often you crave, what you crave and in what settings those cravings occur.   In behavior science, before we try to change any habit, we do an assessment like this to look at the person’s current patterns so that we can set goals for small, stepwise changes. You’ll likely notice a pattern quickly (e.g., I always want something sweet with my 10 a.m. coffee). Then you can put some measures in place to deter this craving or make a healthy choice before it happens (e.g., I’ll start bringing a piece of fruit to eat with coffee so I don’t grab a muffin from the break room).   With a little mindfulness, you can ditch the ''good food, bad food'' attitude! Plan carefully and stay in tune with your body to make sensible decisions that will satisfy your cravings and promote weight loss.        References:   James A.K. Erskine & George J. Georgiou. 4 February 2010. Effects of thought suppression on eating behaviour in restrained and non-restrained eaters. Appetite 54, 3 (2010):499-503.   Jennifer S. Coelho, Janet Polivy, C. Peter Herman. 16 May 2006. Selective carbohydrate or protein restriction: Effects on subsequent food intake and cravings. Appetite 47, 3 (November 2006): 352-360.   David B. McAdam, Kevin P. Klatt, Mikhail Koffarnus, Anthony Dicesare, Katherine Solberg, Cassie Welch, & Sean Murphy. The effects of establishing operations on preferences for tangible items. Journal of Applied Behavior Analysis 38 (2005): 107-110.   Anna Massey & Andrew J. Hill. 18 January 2012. Dieting and food craving. A descriptive, quasi-prospective study. Appetite 58, 3 (June 2012): 781–785. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1770

14 Must-Try Recovery Tools for When You're Crazy Sore After a Workout

It’s often a killer workout that leads to lounging around on the couch (hey, you earned it). But when you can't stop your thighs from wobbling, you’re reminded that there are probably better ideas.

If you want to wake up for tomorrow’s workout and not waddle around like a duck—or someone with a stick up their a$s—then you’re going to need at least one of these recovery tools. Some of them (foam rollers, sticks, and balls, for example) provide deep-tissue massage that helps increase blood flow, in turn speeding up recovery; others (wraps and salts) decrease inflammation to reduce post-workout soreness. Regardless of which you choose, you’re looking at better fitness results in a shorter amount of time, because when you’re not feeling sore AF, you’re ready to get after it that much sooner.  

1. SKLZ Barrel Roller Consider this your introduction to foam rolling, a form of self-myofascial release you want to get in the habit of doing after every tough workout. Roll it over your quads, hamstrings, IT bands—basically anywhere that feels tight—and when you feel that hurts-so-good sensation, release as much bodyweight onto the roller as you can bear. The more you sink into it, the more you’ll feel it, but trust us, the relief is all kinds of worth it. ($55.99; amazon.com) 2. RolFlex Endorsed by the head trainer for the L.A. Lakers, this kinda-wacky-looking recovery tool actually works. The obvious use is for larger muscles of your lower body, but thanks to the ergonomic design and interchangeable attachments, you can target hard-to-roll spots like arms, neck, and wrists with ease.  ($59.95; amazon.com) 3. The Stick Travel Stick When your main objective is to pack nothing but a carry-on for that out-of-state race, the first thing to go is a foam roller. (Or, let’s be honest, it’s not even making it into the suitcase on the first try.) That’s why the Travel Stick is ideal: It takes up very little room—you can even throw it in an oversize purse or backpack—and you can customize how deep of a massage you want based on how much pressure you apply. ($27.42; amazon.com) 4. The Pressure Positive Backnobber II Nearly 800 customers give this an almost perfect score on Amazon, so you know it’s gotta work. The curvy accessory is designed to get at hard-to-reach places in your neck, shoulders, and back: Hook one end over your shoulder and apply as much pressure as you can handle to those sore areas. While it does break down into two parts for easy travel, it may look like you’re trying to shank someone if you pull this thing outta your bag…so maybe save it for the hotel room. ($29.95; amazon.com) 5. Moji Foot PRO If there’s one area that doesn’t get enough love, it’s your feet—and the more than 100 muscles, tendons, and ligaments found within them. But a little TLC can prevent a lot of injuries, so pop this little guy in the freezer before you head to work or for a long run. By the time you get back, the stainless steel spheres are ready to give your barking dogs a cold, muscle-relieving massage. ($31; amazon.com) 6. TriggerPoint MB2 Massage Roller If back issues wreak havoc on your workouts (or your life), this roller is your new go-to recovery tool. Designed to be adjustable, it can extend to target the larger muscles of your back or shrink down to work the tiny muscles along your spine. This can help improve flexibility; release tightness; and support good, upright posture. (You know, to combat all that hunching over you do at your desk all day.) ($24; amazon.com) 7. TheraBand Stretch Strap Stretching always feels better when you have someone there to help you push a little farther, but let’s be real—how often is someone actually nearby to stretch you out? Tossing this strap into your gym bag is a better bet. It helps you move deeper into a stretch, and it even has numbers spaced across the loops so you can easily track improvements to flexibility and range of motion. Use the toe loops to address heel pain and prevent plantar fasciitis, and the big ones for hamstring, quad, and lower back movements. ($16.30; amazon.com) 8. Gaiam Athletic MaxStrap When reaching up (or over) to touch your toes is damn near impossible, a cotton strap can give the stretch support you need without digging into your skin. This one is extra long, so tall athletes aren’t left to deal with tight muscles solo. ($12.98; amazon.com) 9. Dr. Cool Large Wrap Ice packs are a solid part of the RICE method (rest, ice, compression, elevate), but more often than not they slide off and refuse to stay put. This wrap stays in place and offers compression, knocking out two steps in one. ($27.26; amazon.com) 10. Dr. Teal’s Epsom Salt Soaking Solution If you can’t stand the thought of an ice bath—or simply don’t ever feel the need to torture yourself—opt for a relaxing hot water soak instead. Toss in two cups of epsom salt while you’re at it (fragrant varieties offer up ~aromatherapy spa~ vibes), so the minerals can absorb into the skin, providing much-needed relief for sore muscles. ($4.89; target.com) 11. 2XU Refresh Recovery Tights Whether compression works during a workout is debatable, but research shows donning tight gear after may help speed up post-recovery results. Lower-leg compression, running mechanics, and economy in trained distance runners. Stickford AS, Chapman RF, Johnston JD. International journal of sports physiology and performance, 2014, Jun.;10(1):1555-0265. And while the price point is a bit high, these babies help increase blood flow and reduce muscle stiffness and swelling after a killer leg day. Worth it. ($99.95; amazon.com) 12. EC3D Crew Twist Sock Not everyone wants to alert the world that they’re wearing compression gear. These crew socks go unnoticed, but the benefits don’t. You can twist the material to help correct pronation or supination and ease plantar fasciitis pain—finally, a neutral stride that doesn’t leave you feeling weak in the knees. ($25; ec3dsports.com) 13. Zensah Compression Ankle/Calf Sleeves It’s nice when recovery gear looks cool, but it’s even better when the design elements actually serve a purpose. The fold-over cuff on these sleeves slides over the arch of your foot to provide structural support that fights plantar fasciitis pain, the chevron ribbing helps relieve shin splints, and the pin-point compression gives targeted calf and ankle support. ($39.99; amazon.com) 14. Lorpen Compression Light Calf Sleeves These medical-grade calf sleeves aren’t your average slip-on socks. With 30 mmHg in the ankle and 20 mmHg in the calf (the higher the mmHG, the tighter it feels), the graduated compression helps send de-oxygenated blood back to your heart (for a quick pick-me-up), and it may reduce calf-muscle vibrations so you feel less sore after a day of sprints. ($34.99; amazon.com)

 

9 Portable Breakfasts You Can Make in a Muffin Tin

We know we're supposed to eat breakfast every morning, but on the days when we're already scrambling (so, every day), we tend to push it off. What we really need is a breakfast that can rush out the door with us, and these bite-size meals prepped in a muffin tin fit the bill. Simple, healthy, and totally transportable, they’ll make your mornings easier—and tastier. 

1. Egg and Hash Brown Cups Frozen hash browns bake into perfect “nests” for eggs, veggies, and cheese in these individual mini meals. Throw a few in a tupperware box for a balanced, on-the-go option.  2. Frozen Yogurt Granola Berry Bites These cool and crispy treats could stand as a dessert recipe or a snack recipe, but since they're full of granola, yogurt, and berries, we think they’ve got breakfast written all over them—especially if you swap store-bought granola for homemade and regular yogurt for Greek. 3. Mini Ham and Cheese Quinoa Cups Don’t be fooled by their size: With eggs, veggies, cheese, and ham in each serving, these cups pack a impressive nutritional punch. They're like a smaller, healthier quiche. We like it. 4. Banana and Chocolate Chip Oatmeal Cups Baked oatmeal is a wonderful thing, but we usually only see it in the casserole dish. This recipe transfers it over to muffin tins and we're kiiiinda obsessed. Each muffin is studded with chocolate chips to make breakfast feel just a bit more special, but the banana base keeps it mostly healthy. 5. Vegetable Egg and Toast Cups Sometimes you just need to stick to the basics, and this recipe is like that, but better. Good ol’ whole-wheat bread forms the “cups” here, and those are filled with vegetables and eggs. It's a reliable way to get in a nutritious, meatless breakfast. 6. Grab-and-Go French Toast Cups French toast that you don't need a fork and knife for? Pretty much a dream come true. The recipe calls for homemade bread, but go ahead and use any thick toast you’d like to hold in all of that buttery, eggy filling. 7. Paleo Egg Cups Even if you don’t follow a Paleo diet, these five-ingredient, low-carb cups are likely to appeal to you (because bacon). Since they're pressed into muffin cups, the meat crisps up to hold the eggs and asparagus in each protein-packed serving.  8. Apple Banana Quinoa Breakfast Cups This is one of those glorious recipes that can be taken more as guidelines than specific instructions—it's perfect for customization based on your favorite fruit, spices, and other fun add-ins. But if that's not your thing, the original is pretty dang good as is. 9. Make-Ahead Frozen Oatmeal These are frozen instead of baked, so you have a choice: Pop them in the microwave for a really quick bowl of oatmeal or eat them frozen for a refreshing meal on the go. 

Originally published June 2016. Updated March 2017.

An 8-Ingredient Meal-Prep Plan Made for Vegetarians

Planning a meatless menu for the week has its pluses and minuses. On one hand, you don’t need to worry about using up chicken breast or ground beef before it gets wonky on you. On the other, it can be dangerously easy to buy way more produce than you can finish in five days, skimp on protein, or find yourself in a recipe rut when you’re trying to stick to affordable, veggie-based meals.

Not anymore, friends. With this meat-free meal-prep plan that calls for just eight ingredients and some weekend prep, we'll show you how to get inexpensive and well-balanced meals from Sunday through Thursday without getting bored with what's on your plate.

STEP 1: Head to the grocery store.

Take, oh, about 45 seconds to write down your list—or simply screenshot this list to bring with you to the supermarket (because we know you never forget your phone).  

Storage Containers:

  • 4 airtight containers (1 for cooked brown rice, 1 for cooked spaghetti squash, 1 for roasted broccoli, 1 for chickpeas)
  • Plastic wrap for the avocado (or an avocado saver)
STEP 2: Prep everything in 30 minutes.

Devoting a bit of extra time on Sunday will make for effortless eats all week.

1. Cook brown rice. If you’ve got a rice cooker, simply follow the instructions. For the stovetop method, combine rinsed rice with about 3/4 cup water and a pinch of sea salt in a pot, then bring to a boil over high heat. Turn off the heat, place a lid on the pot, and let it hang out for about 10 minutes. Fluff with a fork, cool, and then store the rice in an airtight container.2. Cook the spaghetti squash. Check out our foolproof, step-by-step guide to get it justttt right. Store in an airtight container once cooled.3. Roast the broccoli. If your oven is big enough, you can save some time and roast your broccoli alongside the squash. Break off florets from the head; place on a baking sheet; and drizzle with a bit of olive oil, sea salt, and pepper. Roast in a 400-degree oven for about 20 minutes or until you see the tops getting slightly brown. Once cooled, store in an airtight container. Fast alternative: Broil the broccoli on high for 10 minutes for extra crispy florets.4. Rinse chickpeas. Drain and rinse the chickpeas from the can and store them in an airtight container.5. Spinach, avocado, and feta can stay as is until you need them. Bagged spinach is usually pre-rinsed, so you’re all set there. Cut into the avocado and open the box of crumbled feta only right before you use them. Rub a dab of olive oil on the avocado flesh you're not using and wrap in plastic to prevent it from going brown on ya.6. Store tahini. Tahini can last up to six months, so even though you only need three tablespoons this week, you can look forward to using this flavorful sesame seed butter for as long as it will last (which we don't predict will be very long since you'll want to just stick a spoon in it). Check the instructions on the bottle to see if it needs to be refrigerated.

STEP 3: Celebrate the fact that 5 vegetarian dinners are ready for the week.

Enjoy the delicious rewards of your Sunday labor with easy dinners through Thursday night (and then get a well-deserved night out on Friday).

Satisfying Sunday
  • 1/2 cup brown rice
  • 1/4 cup feta
  • 1/2 cup chopped baby spinach
  • 1/2 cup roasted broccoli
  • 1 tablespoon tahini

How to eat: Nuke the rice to get it warm (drizzle 1/2 teaspoon of water to keep it from going dry in the microwave), then stir in the chopped spinach and feta. Season with sea salt and pepper to taste. Serve with broccoli on the side, drizzled with tahini for extra flavor.  

Meatless Monday
  • 1/2 spaghetti squash
  • 1/2 avocado, diced
  • 1/4 cup chickpeas

How to eat: Reheat the spaghetti squash on the stove or in the microwave with a drizzle of olive oil. Toss avocado and chickpeas with salt and pepper, and add to the bed of spaghetti squash.

Tahini Grain-Bowl Tuesday
  • 1/2 cup brown rice
  • 1 cup roasted broccoli
  • 1/4 cup chickpeas
  • 2 tablespoons tahini

How to eat: Combine brown rice, broccoli, and chickpeas in a bowl; season with salt and pepper; and drizzle with (a ton of) tahini.

White Wine Wednesday
  • 1/2 spaghetti squash
  • 1/2 cup feta
  • 1 cup spinach

How to eat: This recipe needs about a minute on the stove as you heat up your spaghetti squash in some olive oil; throw in the spinach for the last 30 seconds to get it wilted. Take it off the stove and stir in the feta. Season with pepper to taste. And then pour yourself a glass of white wine, since you're halfway done the work week.

Throw-It-All-In Thursday
  • 1/2 cup spinach
  • 1/2 avocado
  • 1/2 cup chickpeas
  • 1/2 cup roasted broccoli
  • 1/4 cup feta

How to eat: Top a bed of spinach with the rest of the ingredients, then drizzle with olive oil, sea salt, and pepper. It’s filling enough to hold you over during happy hour, but light enough so that you can still partake in midnight munchies (if that's your thing).  

By Decade’s End, Calif. Estimates It Would Lose $24B Annually Under GOP Health Plan

California would lose $24.3 billion annually in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a state analysis released Wednesday.

The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on Medicaid spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said.

“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”

Her boss, department director Jennifer Kent, went further:  “It’s challenging to see how it would not … jeopardize the entire program.”

The analysis, based on internal cost, utilization and enrollment data, was done by the health care services department and the Department of Finance and was shared with California’s congressional delegation.

In 2020 alone, the analysis estimated, the state would lose $6 billion; by 2027, the annual loss would reach $24.3 billion.

Kent said that when faced with shortfalls in the past, the state has made cuts to optional benefits such as adult dental care. The state also could set lower provider rates, or restrict who is eligible. “These are all decisions that California and other states would have to grapple with in the future if this were to be adopted as it is proposed today,” she said.

The impact would vary, of course, depending on the state’s fiscal health.

The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding to states has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.

The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries. The new bill would scale the expansion back.

Sally Pipes, president of the San Francisco-based Pacific Research Institute, said the expansion of Medicaid was too costly and should have never been included in the ACA. “These programs are not sustainable, unless you are going to tremendously increase taxes on the middle class,” she said.

Pipes said Medicaid funding should be converted from entitlements into block grants and states should be left to decide how to structure their programs. “More and more people are thinking they are entitled to this and entitled to that and these programs are expensive and not efficient,” she said.

The cuts to Medi-Cal and the restructuring of the program will be better for the California economy, Pipes said.

Meanwhile, Gov. Jerry Brown, who was attending an anniversary celebration for the Affordable Care Act in Washington, D.C., had sharp words Wednesday for President Donald Trump and what he called his “fake health care bill.”

“In California, we’re not talking about a few thousand – we’re talking about millions of real people getting hurt – getting diseases that will not be cured – having heart attacks, not being able to go to a hospital or get a doctor,” the governor said in his prepared remarks.

California was among the most aggressive states in the nation in implementing the Affordable Care Act, and the majority of new enrollees came through Medi-Cal.

Medi-Cal now provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million of those people became newly eligible for the publicly funded health coverage through the Medcaid expansion. That helped reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the UC Berkeley Labor Center for Education and Research.

The Medicaid program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services.

The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.

The California Hospital Association did its own analysis and concluded that at least three million people would lose coverage under the GOP plan, and hospitals could see their bad debt and charity care increase by $3 billion per year.

“As more people lose coverage, they are still going to have health issues, and the hospital is the only place in the health care system required under federal law to provide care,” said Jan Emerson-Shea, vice president of external affairs for the association.

Health officials estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.

The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.

According to the analysis, the state would face additional losses from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.

A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.

Ken Jacobs, chair of the center, said the Republican plan would also result in job losses because of reduced federal funding. Jacobs said both the center’s and the state’s calculations point to a significant financial impact on California if the GOP bill becomes law.

“It’s hard to see where else in the state budget this could be pulled from,” he said. “This would be a very big hit on the budget, the health system and the economy of California. … And the implications for people’s health are serious.”

This story was updated.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

By Decade’s End, California Estimates It Would Lose $24 Billion Annually Under GOP Health Plan

California would lose $24.3 billion annually in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a state analysis released Wednesday.

The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on Medicaid spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said.

“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”

Her boss, department director Jennifer Kent, went further:  “It’s challenging to see how it would not … jeopardize the entire program.”

The analysis, based on internal cost, utilization and enrollment data, was done by the health care services department and the Department of Finance and was shared with California’s congressional delegation.

In 2020 alone, the analysis estimated, the state would lose $6 billion; by 2027, the annual loss would reach $24.3 billion.

Kent said that when faced with shortfalls in the past, the state has made cuts to optional benefits such as adult dental care. The state also could set lower provider rates, or restrict who is eligible. “These are all decisions that California and other states would have to grapple with in the future if this were to be adopted as it is proposed today,” she said.

The impact would vary, of course, depending on the state’s fiscal health.

The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding to states has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.

The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries. The new bill would scale the expansion back.

Sally Pipes, president of the San Francisco-based Pacific Research Institute, said the expansion of Medicaid was too costly and should have never been included in the ACA. “These programs are not sustainable, unless you are going to tremendously increase taxes on the middle class,” she said.

Pipes said Medicaid funding should be converted from entitlements into block grants and states should be left to decide how to structure their programs. “More and more people are thinking they are entitled to this and entitled to that and these programs are expensive and not efficient,” she said.

The cuts to Medi-Cal and the restructuring of the program will be better for the California economy, Pipes said.

Meanwhile, Gov. Jerry Brown, who was attending an anniversary celebration for the Affordable Care Act in Washington, D.C., had sharp words Wednesday for President Donald Trump and what he called his “fake health care bill.”

“In California, we’re not talking about a few thousand – we’re talking about millions of real people getting hurt – getting diseases that will not be cured – having heart attacks, not being able to go to a hospital or get a doctor,” the governor said in his prepared remarks.

California was among the most aggressive states in the nation in implementing the Affordable Care Act, and the majority of new enrollees came through Medi-Cal.

Medi-Cal now provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Medcaid expansion. That helped reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the UC Berkeley Labor Center for Education and Research.

The Medicaid program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services.

The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.

The California Hospital Association did its own analysis and concluded that at least three million people would lose coverage under the GOP plan, and hospitals could see their bad debt and charity care increase by $3 billion per year.

“As more people lose coverage, they are still going to have health issues, and the hospital is the only place in the health care system required under federal law to provide care,” said Jan Emerson-Shea, vice president of external affairs for the association.

Health officials estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.

The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.

According to the analysis, the state would face additional losses from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.

A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.

Ken Jacobs, chair of the center, said the Republican plan would also result in job losses because of reduced federal funding. Jacobs said both the center’s and the state’s calculations point to a significant financial impact on California if the GOP bill becomes law.

“It’s hard to see where else in the state budget this could be pulled from,” he said. “This would be a very big hit on the budget, the health system and the economy of California. … And the implications for people’s health are serious.”

 

 

This story was updated.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Video Help Is On Way For Family Caregivers Who Must Draw Blood Or Give Injections

Renata Louwers has a hard time getting her blood drawn. The needle, the pinprick of pain, the viscous liquid flowing out of her arm — they make her queasy.

So, Louwers had to steel herself when her husband, Ahmad Khoshroo, developed metastatic bladder cancer four years ago at age 72.

Within months, as a tumor pressed on his spine, Khoshroo was taking heavy-duty opioids and Louwers was administering his medications. When he developed blood clots following a stay in intensive care, she injected a blood thinner into his belly.

Figuring out what to do as her husband’s eventually fatal disease progressed was a nightmare. Louwers remembers getting hastily delivered, easily forgotten instructions from hospital nurses and, later, limited assistance from a home health agency. “It wasn’t much, and it was incredibly hard,” she said.

Now, groups around the country are mobilizing to help family caregivers like Louwers manage medications, give injections, clean catheters, tend to wounds and perform other tasks typically handled in medical facilities by nurses or nursing assistants.

In December, 15 organizations joined a new national consortium, the Home Alone Alliance, devoted to providing better training and instructional materials for family caregivers. Founding members include the AARP Public Policy Institute, the Family Caregiver Alliance, the United Hospital Fund and the Betty Irene Moore School of Nursing at the University of California, Davis.

This week, the alliance released a series of 10 short videos (five each in English and Spanish) designed to help caregivers deal with seniors who use canes or walkers and need help getting up or down stairs, into a wheelchair, or in and out of a tub or a shower.

Two of the videos deal with falls — the most common cause of injury among older adults.

This summer, nine videos on wound care and topics will be added and include dealing with newly sutured wounds, bed sores, cellulitis and diabetic foot care, among other topics, and, by the end of the year, another 20 videos should be available.

Potential topics include nutrition, the use of specialized equipment such as nebulizers, feeding tubes and oxygen tanks, and a revised series on medication management — a topic profiled in a pilot project for the alliance.

Organizations across the country will be free to put the videos on their websites. The goal is to disseminate them as widely as possible and “bridge the gap between what family caregivers are expected to do and what we actually teach them to do,” said Susan Reinhard, director of AARP’s Public Policy Institute.

That gap was highlighted in 2012, when AARP and the United Hospital Fund’s Families and Health Care Project published a groundbreaking report on medical and nursing tasks undertaken by caregivers. It found that 46 percent helped patients who required specialized care, but few got adequate training.

After the study’s publication, AARP started compiling educational materials from around the country that addressed caregivers’ increasingly complex responsibilities. There wasn’t much available.

With the United Hospital Fund, AARP convened focus groups and asked people what would be helpful. Don’t overwhelm us with information; break the material into chunks focusing on concrete tasks, they said. And tell us a story that we can relate to, involving people like us — not doctors and nurses, they requested.

Ongoing research into what works, from family caregivers’ perspective, will be an integral part of the Home Alone Alliance. And while videos will be a core component of the consortium’s offering, they won’t be the only one.

“It may be that within certain Asian communities, a video isn’t the best approach — we may want to partner with Asian resource centers and do ‘train the trainer’ sessions about caregiving,” said Heather Young, founding dean and a professor at the Betty Irene Moore School of Nursing at UC Davis.

In African-American communities, churches are a pillar of caregiving support and the focus may be on “helping congregations build their capacity,” Young said. “You can equip one person at a time all you want, but if there isn’t a broader context of support, a net around them, it’s very difficult to sustain the caregiving.”

Meanwhile, alliance members are developing plans for disseminating materials. The Family Caregiver Alliance will incorporate them in a new online platform for caregivers, FCA CareJourney — a source of support and resources that is still under development.

FCA began producing videos for family caregivers about four years ago; its Caregiver College series and SafeAtHome series have been watched by about 500,000 people to date. “We’re going to a more visual information exchange society,” said Kathleen Kelly, FCA’s executive director.

The U.S. Department of Veterans Affairs partnered with AARP in producing the alliance’s video series on mobility. It plans to post the videos on the VA’s caregiver website and encourage their use by patients discharged from rehabilitation and those served through its home-based primary care program, said Meg Kabat, national director of the VA’s Caregiver Support program.

Recognizing the value of videos, the VA’s Office of Rural Health has created a 20-module series on caring for someone with dementia and a five-part series on managing challenging behaviors associated with dementia. An extensive compilation of materials on various health conditions, Veterans Health Library, is also online, and another valuable resource for caregivers.

What’s missing from the current offerings is advice on dealing with older adults who are frail and have multiple conditions. Catherine Yanda’s 91-year-old mother, Mary, is in this situation: She has end-stage dementia, sarcopenia, heart disease, incontinence, frequent skin tears and difficulty swallowing — a set of problems that Yanda has had to figure out how to manage, largely on her own.

“I learn what to do as it happens,” said Yanda, who turns to FCA’s website for support and websites for nurses for information. “You go to whatever site helps you deal with the problem you’re trying to address. I’m lucky because I have the belief system that I can do it. But for some people, it’s just too much.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

In Deep-Blue State, Millions in Reddish Heartland Are Counting On Medicaid

FRESNO, Calif. — In 2012, when Jerry Goodwin showed up at a clinic with intense pain and swelling in his legs, doctors called for an ambulance even though the hospital was across the street. That generated a $900 bill — just the beginning of a nearly three-year ordeal for Goodwin, who was uninsured.

Diagnosed with cellulitis and an irregular heartbeat, Goodwin managed to get his emergency care costs covered through the hospital but then faced month after month of bills for follow-up care and medications.

Finally, in 2015, he was able to sign up for Medicaid coverage, which was expanded under the Affordable Care Act to cover many single adults without children. “That was a big relief,” said Goodwin, 64.

Now Goodwin and people like him are worried all over again.

Under Republican efforts to repeal, replace or reform the health law, many people on Medicaid — the nation’s single-largest insurer, with 72 million beneficiaries — could see their coverage slashed. The biggest chunk of them — 13.5 million — live in California. The state predicted Wednesday it could lose $24 billion in federal funding annually by 2027 under the current GOP proposal.

Among the hardest hit regions would be the Central Valley, the state’s agricultural heartland, stretching hundreds of miles from Redding to Bakersfield. Toward the south, in Fresno County, about half the population of 985,000 relies on Medi-Cal, as California’s Medicaid program is known. In adjacent Tulare County, 55 percent of the more than 466,000 residents were enrolled in Medi-Cal as of January 2016.

Much has been said about the plight of conservative voters in the Midwest who rely on Medicaid, a program the Trump administration and congressional Republicans are determined to shrink. But despite its reputation as a deep-blue state, California also has several red — or reddish — counties in its interior with millions of low-income people who depend heavily on Medicaid. Many live in congressional districts represented by Republicans who want to scrap or change the Affordable Care Act, also known as Obamacare.

The current Republican bill, the American Health Care Act, would cut Medicaid funding by 25 percent by 2026, covering 24 million fewer people than today, according to the Congressional Budget Office.

“These are remarkable estimates,” said John Capitman, the executive director at the Central Valley Health Policy Institute and a professor at California State University, Fresno, referring to the CBO projections. “The level of cuts are devastating, and for California and the Central Valley, this represents a huge loss.”

The bill faces opposition from the left and right and is undergoing last-minute changes in the run-up to a House floor vote Thursday. Despite several protests in the valley and around the state, at least half of Republican lawmakers in the state appear poised to support it; several others are noncommittal.

U.S. Rep. Devin Nunes, whose congressional district includes portions of Tulare and Fresno counties, likes the proposal, saying it will improve care for everyone, including current Medi-Cal participants.

“Medi-Cal is a broken healthcare system that’s been completely mismanaged by the State of California,” Nunes said in a recent statement.

Capitman said Medi-Cal is vital in the Central Valley because of its high poverty rate, uneven access to care and pockets with very poor health outcomes. Many of these communities also depend on the Prevention and Public Health Fund, which was established by the ACA to fight chronic diseases and also is in peril, he said.

The valley suffers high rates of diabetes, obesity and heart disease. The area has some of the country’s dirtiest air, triggering epidemic levels of asthma. Wage stagnation and high unemployment contribute to stress and poor mental health.

Some areas are far better off than others. Within 10 miles, Capitman said, you can find up to a 20-year difference in life expectancy. On average, life is much shorter for residents in Southwest Fresno, for instance, where heavy industry soils the air, homeless people camp on sidewalks, and fences cage in lots overgrown with grass and weeds.

Not far away, Petra Martinez, a former fieldworker, recently waited to see a doctor at a crowded downtown clinic. At 86, she receives coverage from both Medi-Cal and Medicare, the federal insurance program for the elderly. She needs medication for arthritis, epilepsy and diabetes, all of which is paid for her through her dual coverage.

Though the proposed House bill seemingly would not shrink spending on people with dual coverage, she is wary of what lies down the road.

“I’d like to think that we [seniors] will be OK, that maybe we won’t be affected by whatever changes are coming, but who knows?” Martinez said. “I don’t want to have to ask my children for money to go to the doctor.”

Dr. J. Luis Bautista, an internist at the clinic, estimates he’s seen a 20 percent increase in patient visits since the rollout of the ACA in 2014. The majority of his patients are on Medi-Cal.

“These are the people who usually wait until they’re very sick to come,” Bautista said. “We’ve seen people with high blood pressure who come in when they already have eye problems and heart problems. … They waited too long.”

But since the ACA rolled out, he said, preventive visits seem to have increased.

Fifteen miles outside the city of Fresno is Sanger, a largely Latino town of 25,000 where almost a quarter of residents live in poverty, according to the U.S. Census.

Here a neighborhood of newer houses with commuter residents isn’t far from another that lacks sidewalks and is strewn with aging or abandoned businesses and chain stores.

On a recent day, a hairstylist was tending to a client in a downtown salon nestled among boutiques, cafes and other small businesses. The stylist said she and her two teenagers are on Medi-Cal — and so are most of the people she knows. A single mother, she said she works six days a week but can’t afford to buy health coverage.

The salon’s owner interjected that she doesn’t oppose greater restrictions on who gets Medi-Cal — but plans on the state’s insurance exchange should be more affordable, so people will be drawn to buying coverage.

The women asked that they and the business not be identified.

Less than an hour southeast of Fresno, Iliana Troncoza lives in the city of Tulare, part of a heavily agricultural county of the same name. The county has one of the lowest incomes per capita in California.

Troncoza, a 47-year-old homemaker who takes care of her ailing husband, gets her health care at Altura Centers for Health, which runs seven clinics in the city. The thought of Medi-Cal cutbacks fills her with anxiety. Both she and her daughter, a college freshman, rely on the program for coverage.

Troncoza had gone without coverage for six years before qualifying under the ACA expansion. She traveled to Jalisco, Mexico, to remove a breast cyst because couldn’t afford the procedure in the U.S. Now, in her city, she can receive mammograms and ultrasounds, and has been able to obtain medication for her depression and anxiety, she said.

“It’s horrible to think that our Medi-Cal depends on people who don’t understand our situation,” Troncoza said.

Graciela Soto, CEO of Altura clinic system, said 75 percent of its patients are on Medi-Cal and 9 percent of patients are uninsured, mostly because of their immigration status. It’s quite a difference from 2012, before the ACA was implemented, when 50 percent of patients were on Medi-Cal and 35 percent uninsured, she said.

“The Medicaid expansion was wonderful for our patients,” Soto said.

Through the ACA, Soto said, many young women were able to access free or affordable birth control. That’s important, she said, because Tulare County has among the highest teen pregnancy rates in the state.

The region has a large population of migrant farm workers, many of whom don’t qualify for Medi-Cal. But a substantial portion of Latinos do qualify, as do non-Hispanic whites like Goodwin.

Among whites, the need for mental health and substance abuse services is growing, research suggests. Drug overdoses, alcohol abuse and suicide have significantly contributed to rising death rates, according to a study out of the Center on Society and Health at Virginia Commonwealth University.

In Fresno County, for example, the rate at which middle-aged white adults are dying from accidental drug poisoning has tripled since 1990, according to the report.

Some residents have turned to activism in their efforts to preserve ACA coverage. In January, Greg Gomez, a councilman for the city of Farmersville in Tulare County, led a small-scale protest outside Nunes’ office in Visalia.

It wasn’t just about politics — it was personal. Three of Gomez’s children are covered by Medi-Cal.

“The monthly premium to get my whole family covered by my employer would be about $2,000,” said Gomez, a computer systems engineer for Tulare County and former president for the local chapter of the Service Employees International Union. “That is totally out of reach. That’s why we need Medi-Cal. And that’s the story of a lot of Tulare residents.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Texas Braces For Medicaid Cuts Under GOP Health Plan

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Many in Texas are keeping a close eye on the Republican bid to replace the Affordable Care Act. One of the big changes is how it would affect low-income people, seniors and people with disabilities who all get help from Medicaid. And Texans on both sides of the political spectrum say the Lone Star State is not going to fare well.

As the GOP bill, the American Health Care Act, works its way through Congress, Anne Dunkelberg, with the left-leaning Center for Public Policy Priorities in Austin, said she’s a little stumped.

“I have worked on Medicaid and uninsured and health care access issues in Texas for well over 20 years,” she chuckled. She said this bill leaves the fate of some current funding streams unclear, and there’s one pot of money she’s particularly concerned about. Texas has struck deals with the federal government under something known as a 1115 waiver to help reimburse hospitals for the cost of caring for people who don’t have insurance. And Texas has more uninsured residents than any other state.

“About half of what Texas hospitals get from Medicaid today comes through payments that are outside from the regular Medicaid program,” she said, which adds up to $4 billion in federal funds every year.

But even if Texas gets to keep all that money, there’s another issue — the GOP plan will reduce how much the federal government pays for Medicaid. It will either cap how much money states get for Medicaid from the federal government for every person they cover. That’s called a per-capita cap, and the payments under that formula would start in 2020, but would be based on how much the state spends this year. Or, in line with this week’s modification of the GOP bill, it would let states choose a lump sum, or block grant, also likely to cut the federal support Medicaid gets.

Adriana Kohler with Texans Care for Children, an advocacy group based in Austin, said Texas already leaves too many people without care.

“Last legislative session there were cuts to pediatric therapies for kids with disabilities enrolled in Medicaid,” she said. The cuts caused some providers to shut their doors, which left some children without services, she said. “That’s why these cuts coming down from the ACA repeal bill are very concerning to us.”

In Texas, she said, children, pregnant women, seniors and people with disabilities will bear the brunt of any belt-tightening. These populations make up 96 percent of people on Medicaid in Texas. That’s why, Dunkelberg said, the program as is should not be the baseline for years to come.

“They could lock Texas into a lot of historical decisions that were strictly driven by a desire to write the smallest budget possible,” she said.

Some on the right agree Texas is getting a raw deal. Dr. Deane Waldman, with the right-leaning Texas Public Policy Foundation, said there are things he likes in the bill. But in general, he said, “it’s bad deal for Texas. It’s a bad deal for the American people.”

He said it was the right thing for Texas not to expand Medicaid, but this bill punishes Texas for it. Under the GOP bill, states that expanded Medicaid would get more money. And because the initial Republican bill left the door open for states to expand Medicaid before 2020, he worried more states would do that to get in on the deal.

“It’s going to be a huge rush — an inducement to drag in as many people as they can drag in, because the more they can drag in, the more federal dollars they can get,” he said. The GOP’s latest plan, however, makes it impossible for any new states to expand Medicaid and cuts off funding for Medicaid expansion states earlier.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

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