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  • Feb 2 '14

    Sentiments run high regarding the Affordable care Act, but whether one supports the new law or believes it to be a case of government over-reach, the fact is that the ACA is now the law and as nurses we are obligated to make sure that patients and their families understand the basic workings of the law. Nurses are in a position of trust and as such we should be able to address patient's questions and concerns regardless of our personal feelings about the ACA.

    Open enrollment began on October 1, 2013 and there is still much confusion and disinformation as to what the law does and does not cover. If we are to be a resource for our patients and their families we must educate ourselves so that we don't contribute to the confusion. Paying for medical and drug bills is the most common financial problem Americans report having; even more than missed mortgage payments, job loss and home foreclosure. There are millions of people anxious to get insurance or find less expensive insurance and many patients and their families may look to their nurses for answers to questions about how to enroll, how much it will cost and what will be covered. While we may not become experts in the new law, we can certainly make every effort to become as knowledgeable as possible so that we do not misinform or misdirect those who place their trust in us.

    Major changes in the healthcare landscape already took place in March of 2010 when the ACA was signed into law:

    1. Children are now able to remain on their parents health care policies until they are age 26.
    2. Children with pre-existing conditions are now covered.
    3. There are no lifetime limits on coverage.
    4. Preventive care is now free for seniors on Medicare and for people with health insurance.
    5. Prescription drugs are discounted for seniors.
    6. Insurance companies are required to spend at least 80% of their premium charges on medical care.

    After January 2014, no one will be denied health insurance because of a pre-existing condition and all insurance plans will be required to offer the following benefits:
    1. Emergency services
    2. Hospitalization
    3. Prescription drugs
    4. Laboratory services
    5. Pediatric services
    6. Maternity and newborn care
    7. Preventive and wellness services
    8. Ambulatory patient services
    9. Mental health and substance abuse services
    10. Rehabilitative services and devices

    Health insurance exchanges, also known as marketplaces offer several levels of coverage:
    1. Platinum - Patient pays the highest premium and about 10% of costs
    2. Gold - Patient pays about 20% of costs
    3. Silver - Patient pays about 30% of costs
    4. Bronze - Patient pays the lowest premium, but about 40% of out of pocket expenses through co-pays and deductibles.

    ACA Myths and Facts:

    Myth: Insurance will be free

    Fact: Insurance plans will cost money, however many uninsured will be eligible for Medicaid or receive subsidies to buy insurance from an exchange. Some people will pay the entire amount themselves but will be able to choose from different price ranges and plans.

    Myth: There is one government plan that everyone must enroll in.

    Insurance will be offered by both for profit and non-profit companies. Medicaid will be expanded to cover those making up to 138% of poverty level for a family of four ($33,000 annually for a family of four).

    Family size:

    You may be able to get financial assistance if income is below:

    1 family member $46,000
    2 family members $62,000
    3 family members $78,100
    4 family members $94,200
    5 family members $110,300
    6 family members $126,400

    Myth: Health choices will be restricted.
    Fact: Health choices for previously uninsured people will be considerably expanded. The ACA allows people to get insurance through Medicaid or buy it on exchanges giving them access to a greater variety of healthcare providers and services.

    Myth: Medicare premiums will go up.

    Fact: Medicare premiums will not go up under the ACA, however Medicare recipients will now receive drug discounts and free preventative care.

    Myth: Healthcare premiums will go up on individual plans.

    Fact: Persons with pre-existing conditions, women and older people are more likely to see their premiums go down. Co-pays and deductibles may also decrease and limits on how much insurance companies will pay for care will be eliminated. Several studies on insurance premiums expect that more people will pay less (than they did prior to the reforms) than those who will pay more and that those premiums will be more stable and transparent due to the regulations on insurance. It is estimated that about half the people who currently buy insurance on their own today will be eligible for subsidies.

    Myth: Everyone's premiums will go down under the ACA.

    Fact: For a healthy young person who has a low cost, high deductible policy the premiums will likely go up, but the coverage will be better. Those making less that $45,000 annually will probably be eligible for a subsidy.

    Myth: People with health insurance now will lose it next year.

    Fact: Individual and employer sponsored insurance will probably not change any more that it usually does from year to year. Some people may lose coverage because a few insurers choose not to participate in the exchanges or because some of the low cost, high deductible plans now available don't provide the essential health benefits required by the ACA will be discontinued.

    Myth: People who don't buy health insurance will go to jail.

    Fact: The penalty for not buying insurance will be $95 per adult, $47.50 per child, and $285 or 1% of house hold income, (whichever is greater) for families in 2014. In 2015 these penalties will increase to $325 per adult, $162.50 per child, (up to $975 per family) or 2.5% of income for families.

    People without insurance can sign up for a plan anytime between October 1, 2013 and March 31, 2014 to be covered in 2014. For those who sign up by December 23, coverage will start on January 1, 2014. People under 30 and those with low incomes who cannot get other types of insurance may choose a catastrophic plan. These catastrophic plans cost less than other plans, but require patients to pay all health costs except preventative services up to a certain amount, (usually thousands of dollars) after which the insurance company usually will cover the 10 basic services (see above). Subsidies may not be applied toward catastrophic plans.

    Twenty two states and the District of Columbia have expanded their Medicaid programs meaning those making up to 138% of poverty level (about $33,000 for a family of four) will be eligible for Medicaid. Those in other states who do no qualify for subsidies are exempt from fines for not having insurance. See websites below for state by state details.

    Sixteen states and the District of Columbia are operating their own exchanges, seven have created exchanges in partnership with the federal government and the rest are letting the federal government run the exchange.

    In all states, people making up to $45,000 ($94,000 for a family of four) may qualify for
    subsidies to help pay for health insurance.

    Enrollment dates:

    If you buy insurance by -- Insurance begins:
    12/15/2013 -- 1/1/2014
    1/15/2014 -- 2/1/2014
    2/15/2014 -- 3/1/2014
    3/15/2014 -- 4/1/2014
    3/31/2014 -- 5/1/2014

    In subsequent years enrollment will run from Oct 15 thru Dec 7. These waiting periods mean people won't be able to just wait and buy insurance only when they become ill or have an accident.

    Persons seeking health insurance or information about the ACA can go to where they will find a list of insurance companies and they may begin the application process for insurance. It is also possible to enroll by telephone at 800-318-2596 or in person at a certified enrollment location such as a hospital or community center, which may be desirable alternatives as the government website has been experiencing technical difficulties.

    Kaiser Family Foundation: and provide tools to input one's income and get an estimate of what subsidies might be available and how much one might expect to pay for health insurance on the exchanges based on the state in which you reside.

    You can find more information at the following websites:

  • Feb 2 '14

    Quote from thesimpsonslover1
    I'm surprised more nurses aren't contemplating this knowing that their jobs could be on line.
    Nurses will have a continuation of an expanded role in the evolving healthcare system.

  • Feb 2 '14

    You can ask (and have asked) for opinions about what people believe will happen, but you know what they say about opinions and @$$#*!&$-- everybody has one, and a lot of them stink.

    Short answer: We will have to wait to find out. That means that whatever the initial effects may be, it will not likely always be like that, and a certain amount of adjustment will occur over a certain amount of time-- experience suggests that is exactly what will happen.

    But as to a more precise answer your question:
    there can be theories
    there can be opinions
    there can be speculation, and
    there can certainly be bloviation

    ... and we will have to be patient to find out.

  • Jul 27 '13

    They will not share assets? CNA loaned 2 million dollars to NUHW. These two unions have been affiliated for much longer than most are aware of.

  • Jul 27 '13

    Personally, I'm a little disappointed that CNA will no longer be a union for nurses. An environmental service technician is not going to understand the critical issues bedside nurses face. Are dietary staff going to want to strike because nursing has decided to strike regarding a patient safety matter? I'm not saying this to be elitist; I just think adding non-nursing staff runs the potential of diluting the message.

    Maybe I misread the homepage of the NUHW, but it sounds like it includes a lot of staff who are not nurses.

  • Jul 27 '13

    I have been told by my manager that a union contract helps her as a manager because there is a written contract.

  • Jul 27 '13

    Quote from tewdles
    Unions have a place in any employment situation where the employer is not responsive to the needs and well being of the staff. Not all employers are bad and thus, not all work environments benefit from union rep.
    ^This!!! I concur.

    We also have to remember how unions helped shaped how we have set hours...we can't just work ourselves to death, no matter if some facilities out there try to.

    Even if unions are not in every facility, I hope they can move to be a support and a resource for adequate wages, wage increases, cost of living better work conditions, deterrent for workplace violence, discrimination, making work conditions favorable so we there is an opportunity to be able to enjoy the workplace, thus more career enjoyment and less burnout.; as well as improve work-life balance.

    I work somewhere where there is a union. While I'm not a part of it because it is not offered to nurses because of the way our organization classifies us (since we have the ability to be a supervisor) we still have excellent benefits, flexibility, etc. The benefits are pretty lateral across the board. The atmosphere is one of the best I worked in my career.

  • Nov 30 '12

    Yes. I've worked in union buildings and have fired CNAs and nurses.

  • Nov 30 '12

    people get fired from a union all the time. it is not protection against being a jerk. as the above nurse said, enough documentation and warnings in the file should do it. what will happen is they will strike a deal where the worker is let go, but nothing will be on her 'permanent' record. keep after it.

  • Nov 30 '12

    It can be done but it is very difficult. The RN supervisor needs to document all of these behaviors in the form of verbal, then written counsellings. The supervisor needs to engage the assistance of the DON to help sit with this employee during the counsellings. The employee will be allowed to have a union representative present during the counsellings but they are not allowed to keep their job if they are violating the facility's abuse prevention policy by being rude to residents and failing to provide care, and other making residents uncomfortable and frightened. But documentation is the key, each and EVERY instance. Eventually, there will be enough written evidence to suspend and terminate, without union recourse.

  • Nov 30 '12

    Quote from wooh
    How exactly have they shown their dedication to this in the past?
    I understand your point.
    Their press release states this. To my knowledge this is the first time the ANS supported safe staffing ratios. For that i am glad.
    The nurse staffing resolution identifies short-staffing as a top concern for direct care nurses that negatively affects patient care and nurse job satisfaction. It notes that staffing decisions remain largely outside of nurses' control, and that staffing plans lack enforcement mechanisms.

    The resolution requests ANA to "reaffirm its dedication" to advocating for a staffing process, directed by nurses, that is enforceable and that includes staffing principles, minimum nurse-to-patient ratios, data collection, and penalties for non-compliance in all health care settings where staffing is a challenge.
    I was one of the delegates who voted for my state nurses association to leave the ANA. I've been praying that the come around to understand that hospital restructuring and downsizing are not an opportunity. They are bad for patients and bad for nurses.

  • Nov 30 '12

    Quote from herring_RN
    ANA Reaffirms Dedication to Improving Staffing for RNs and Their Patients

    Press Release - American Nurses Association

    How exactly have they shown their dedication to this in the past?

  • Nov 30 '12

    Quote from man-nurse2b
    Yes but what about hospitals creating these "tech" positions that nurses normally do. I recently saw an ad for "critical care tech" and the job description was exactly like what an ICU RN would do. So one has to think about about whether or not laws like these would lead to more nurse positions.
    I certainly think patients are safer with a competent critical care nurse that with a tech.

  • Nov 30 '12

    Quote from gummi bear
    If this were implemented in every state, then would this have an effect on the unemployment rate for nurses? I know that some hospitals have hiring freezes, but they are definitely understaffed. They'd rather have dangerous ratios and "save money", than to provide adequate care.
    Yes but what about hospitals creating these "tech" positions that nurses normally do. I recently saw an ad for "critical care tech" and the job description was exactly like what an ICU RN would do. So one has to think about about whether or not laws like these would lead to more nurse positions.

  • Nov 30 '12

    I'd guess that LTC must be spending all their profits to lobby against mandated staffing ratios. They certainly are not spending it on staffing.