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changes have two things in common: 1) before we made it through each of them, there were some who portended the end of local health departments as a result of that particular change and 2) each change gave us a fundamental skill that made the next change easier. Think about it ... as a result of BBA we became better lobbyists to help politicians, especially at the Federal level, understand the effects of their decisions and a couple of years later most of the worst parts of BBA were repealed. We now have a paid lobbyist and work daily to develop the personal relationships we need with decision - makers to help ensure the public's health is forefront on their minds. The transition to using CPT codes made adopting ICD 10 way easier than anybody predicted. And think of all the technology skills we've learned in the last 20 years that are allowing us to embrace the use of EHRs along with apps and telehealth. So, yeah, Medicaid Reform scares me, but like Isaac Newton I know we stand on the shoulders of giants ... those in our public health family who went before us and built the platforms from which we have learned everything we need to thrive. I know that from these platforms, what we learned last year and what we'll learn here together over the next two days will prepare us to survive and even thrive in the face of any change - related challenges we face. I hope you'll enjoy this conference as much as I expect I will and I hope to see you at lunch, dinner and in the hospitality suite.