Can someone "dumb down" what Obamacare really means?

whoa-now · Aug 15, 2012

Touche!! MBA

uRNmyway, ASN, RN · Aug 15, 2012

But see thats the point I made on an earlier post. If you compare the 45% income tax to the 20% or so I am looking at here, that 25% difference that comes out of your paycheck certainly makes up the difference. In fact, it comes out to around the cost of pretty high end insurance in the US. Or at least it did for how much *I* was paying...

ProgressiveActivist, BSN, RN · Aug 15, 2012

I don't have time to watch the news or read articles so I don't understand much of what is being talked about. Can someone explain to me how it changes for citizens and what it will do to the future of our healthcare system? Particularly, for us nurses.

The ACA is a major overhaul of the healthcare industry. EMRs are required by 10/2014. The need for nurse coders and informatics is going to increase dramatically. At the very least you will need to have Epic, Cerner, Meditech or Eclypsis experience on your resume.

We can expect to see a huge influx of patients in all settings.

Reimbursements will decrease and I think we will have to do even more with less staff. Older expensive nurses are going to suffer even more and be replaced by cheaper inexperienced new grads. The National Nurses Union is going to really expand and become a force like the NEA.

Meaningful use standards in health care will be strictly enforced with heavy fines from the OIG.

The system of incentives and taxes on hospital profits may force some hospitals to close their doors.

There are many of well researched articles on NYtimes.com.

cdsga · Aug 15, 2012

Pay for performance does not work. Just look at the education system-funds for schools who test well-leads to fraud and manipulation of scores to make sure that the stats are straight and the funds are awarded. Same thing will happen to healthcare. Check boxes for regulatory processes being completed on paper. Just to not get payments dropped from Medicare.

I don't think anyone person will do away with Medicare-not unless they want a mass revolution.

I do think socialized medicine sounds good, but in reality it's not. Lets put everything in one pot so everyone can benefit. The people who work hard get the same thing as those who don't????

What are we saying? Healthcare should be a charity? If that were the case then all nurses should be housed, fed and clothed waiving their salary-which you top out at 15 years of service in the current world. Look at where the profits are going-insurance companies. More and more doctors are giving up their offices and working for hospital run medical management groups-which lowers their overhead and makes them an employee rather than a business owner. That has pluses and minuses.

My personal opinion should be better ways of accessing insurance-across state lines. Shop for the benefits you want-form networks like groups that will decrease the amount of premiums.

I don't think the veterans get the best care. VA's are staffed by residents and interns. The nursing care is good. Medical care??? not so sure. I've seen and heard of bad outcomes---remember the issue with HIV and hepatitis from dirty scopes???? That was VA-it took the attention of many to upgrade Walter Reed-not too long ago that hospital was not in the best shape. Thank God for the injured vets from the recent wars-the technology and rehab facilities have been upgraded and are becoming top-notch. But it took exposing the hospital for that to happen.

I think the way of the future is a Mayo Clinic or John's Hopkins type situation. But these are mostly specialty institutions and send the patients back to their primary physicians who have to follow the treatment plans and follow up. How do they cope? They don't get the grants and money through donations that a Mayo type institution does.

I also think it is imperative to limit the buffet of equipment that hospitals purchase-rentals should be the way to go-especially since technology is changing so fast and by the time you buy something it becomes obsolete.

If this Affordable Care Act is to work and all mandates are met-then cutting nursing staff is not an option. Cut something else, limit amount of money spent on superfluous things (marketing/signage/advertising)-and increase the staffing to ensure that these mandates are met-word of mouth and positive patient outcomes speak more volumes than expensive TV/Radio/Print ads. By spending some money on salaries, hospitals and other healthcare facilities can ensure that the payments will come. It's hard to be perfect and meet the goals when understaffed and overworked, not to mention all the pressure when measures cannot be attained due to powers outside the nurses' ability.

Mudwoman · Aug 15, 2012

I don't have time to watch the news or read articles so I don't understand much of what is being talked about. Can someone explain to me how it changes for citizens and what it will do to the future of our healthcare system? Particularly, for us nurses.

I don't have time either, and there are so many comments that contradict, that I don't know what is right or wrong.

However, the hospital that I currently work at is a non-profit Catholic hospital and it has been sold to a for-profit healthcare conglomerate that happens to own the only other hospital in our area. The 2 hospitals will be combined and made smaller and leaner. The rummer mill says there will be substantial lay-offs and the 2 hospitals merge. We have 280 beds, the other hospital has 160 and when it is all over, there will be about 280 beds. Mgmt sends out an email every week that says "oh no!. Layoffs will never happen!" We have a nurse/patient ratio of 5/1 or 6/1. The company that has purchased us uses a 7/1.

We were very hurt and shocked that we were sold. We were told that with Obama care, there will be NO WAY for both hospitals to survive in that climate due to cuts in revenue payments for services and that for both hospitals to make it, they have to combine and be more efficient; use resources in the best way possible.

It will be interesting as we move forward. There will be layoffs and there are not many places for the nurses that get laid off to go here. Many will have to move. Me included.

Hancock330 · Aug 15, 2012

The ACA (too often called "Obamacare" as if he could pass legislation all by himself) is not a perfect bill, but is the result of compromise, as is all legislation that gets passed in this country. Members of Congress USED to have the same choices in health insurance plans as did all of the federal civil service employees in this country. Because of the uproar about them not being eligible for coverage under the "health insurance exchanges" (because, like all of the civil service employees they had access to excellent coverage through their "employer"), they passed a provision that requires them to get coverage via a "health care exchange" when that part of the law goes into effect. The ACA also includes provisions (some of which are going into effect now) to support education of more nurse practitioners to increase the supply of primary care providers in many communities. Two goals of the bill are to get more people to seek preventive treatment and to seek early treatment for illnesses thus preventing more serious illnesses needing more expensive treatment. Hopefully, it will reduce overall expenditures for ERs and ICUs treating people who waited too long to seek care because they couldn't afford the bills. I imagine that more hospitals will establish "urgent care centers" semi-attached to their ERs where people with non-emergent problems can be sent for care, reducing the load on the ERs AND decreasing the perceived advantages of using the ER instead of seeing one's primary care provider during regular office hours.

The bill is intended to make healthcare insurance affordable -- and to strongly encourage even the "young, healthy adults" who think they won't need it to get it anyway. Since young, healthy adults sometimes get injured (while not in a vehicle or on the job) and sick (appendicitis, etc.), they can be a drain on the system if uninsured. Since hospitals that get Medicare or Medicaid payments or any kind of federal funding are forbidden to turn away from their ERs any patient with an emergent condition, a LOT of people are GETTING care and the rest of us are paying for it through higher insurance premiums and taxes. Just as states TRY to assure that everyone who drives a car has at least Liability Insurance in case they damage another's property with that car, the federal government is TRYING to get every adult and family to contribute at least a little toward paying for health care that almost everyone will eventually need.

Again, the bill is FAR from perfect, but after decades of discussion (since Harry Truman was president) something is being done. Like every other law of major proportions in our history, some tweaking and some major adjustments will be necessary. But, if you've been involved in healthcare for very long (I'm now over 4 decades as a nurse) you've seen a LOT of patients who needed healthcare and knew it but didn't want "charity" so delayed until they were forced to seek care due to disability. If we can reduce that drain on our economy and society, I'm convinced it would be a good thing.

Finally, Fact Check (from the Annenberg Public Policy Center from the University of Pennsylvania provides a good attempt at "apolitical" doses of information on Public Policy and political advertisements. Here is a link to its pages on the ACA where they provide a "dumbed down" version of the information about the bill as well as links to sections of the bill for those who want to read the exact wording in the bill: FactCheck.org : Search Results

Give that a try to get specific questions answered.

Snowpoopsie · Aug 15, 2012

NACCHO has a great article by article explanation on their website.

NiteQwill · Aug 15, 2012

And where exactly do we have the money to fund Obamacare? Oh yeah, print more money...

nurseprnRN, BSN, RN · Aug 15, 2012

This is what you want. The first video is made by that noted radical group, Kaiser Health Care. It's an animated video narrated by Cokie Roberts. It is designed to be clear, understandable and nonpartisan. Note that it was made before the law was passed, so some of the verb tenses will be off.

healthreform.kff.org/The-Animation.aspx

Next is the explanation by Medscape of the ten titles in the ACA, the Affordable Care Act. It was prepared for Medscape by John McDonough, DPh MPA, a noted health policy researcher and analyst from Harvard School of Public Health.

Medscape

The ACA -- What’s Really In It?

Medscape: Medscape Access

Title I. Quality, Affordable Health Care for All Americans

This title fundamentally changes the nature and operation of private health insurance in the United States. Beginning in 2014, no health insurer will be able to sell or rate coverage based on an individual''s medical history; most Americans will be required to obtain health insurance; and substantial financial subsidies will be available to low- and moderate-income Americans to help them afford the cost of health insurance. Most states will operate new "health insurance exchanges" to make shopping for health insurance easier. Small businesses and individuals can shop these insurance exchanges for competitive rates. Other important changes in health insurance, including the banning of lifetime and annual benefit limits, were implemented in 2010.

Title II. The Role of Public Programs

This title creates substantial changes to Medicaid, the federal-state program for many low-income persons. Beginning in 2014, all lower-income individuals will be eligible to enroll in their state's Medicaid program, not just those who fit into categories such as disabled, children, or parents. For the first time, Medicaid will become a more uniform national program with uniform eligibility and enrollment standards as well as quality improvement requirements.

Title III. Improving the Quality and Efficiency of Health Care

This title establishes new mechanisms to improve the quality of medical care in the United States by making it more efficient and effective, and more patient-centered. Medicare will be improved with the addition of new preventive benefits for enrollees; and the Medicare Part D drug benefit will be made more affordable by closing the coverage gap known as the "donut hole." Medicare's rate of growth will be lowered to provide about $450 billion in savings between 2010 and 2019, which should fund about half the cost of the ACA.

Title IV. Prevention of Chronic Disease and the Improvement of Public Health

Title IV is the most ambitious law ever passed to promote healthier lifestyles for all Americans and to prevent disease and disability. A National Prevention, Health Promotion, and Public Health Council will devise a national prevention strategy, backed up by a $13 billion Trust Fund. Evidence-based clinical preventive services will be provided in most public and private health insurance policies without cost-sharing. Chain restaurants will be required to post the calorie content of their foods.

Title V. Healthcare Workforce

This title establishes a National Healthcare Workforce Commission to analyze and plan for workforce needs and to make recommendations to congress and the administration. Support is provided to expand the healthcare workforce, especially in primary care. Major expansions for community health centers and the National Health Service Corps are funded.

Title VI. Transparency and Program Integrity

Title VI provides new authority to federal and state agencies to combat fraud and abuse in Medicare, Medicaid, and private health insurance. Drug companies and medical suppliers will report most gifts and other gratuities to physicians for public release on a federal Website. The Patient Centered Outcomes Research Institute is established as a public-private entity to support research on comparative clinical effectiveness. New transparency requirements on the nursing home industry will provide information to protect and empower patients and their families. The Elder Justice Act provides a national framework to combat violence, neglect, and financial exploitation of senior citizens.

Title VII. Improving Access to Innovative Medical Therapies

This title directs the US Food and Drug Administration to develop a regulatory pathway to permit the development, manufacture, marketing, and sale of biosimilar biologic products, generic-like versions of biopharmaceutical drugs. It also ends anticompetitive efforts to keep generic drugs off the market, and offers drug discounts to hospitals and communities that serve low-income patients.

Title VIII. CLASS: Community Living Assistance Supports and Services

This title authorizes a new national and voluntary long-term disability insurance program to provide workers with daily cash payments and support if they become permanently and temporarily disabled. People who enroll in CLASS must pay premiums for a minimum of 5 years. The funding is flexible and can be used for a range of services. No tax money will be used to fund this program. Its only permitted financing source -- enrollee premiums -- must be sufficient for at least 75 years if the Health and Human Services Secretary is to launch the program.

Editor's Note: The Obama administration announced on October 15 that it was abandoning plans for CLASS. Congress is expected to quickly draft legislation to repeal the provisions of this title.

Title IX. Revenue Provisions

This section covers the financing for slightly less than half the cost of the ACA. Key provisions establish new Medicare taxes on high-income wage earners, as well as new taxes on pharmaceutical manufacturers, health insurance providers, and medical device manufacturers. Also included is an excise tax on high-cost, employer-provided health insurance; changes to health savings accounts and other individual health accounts; and a 10% tax on indoor tanning services.

Title X. Strengthening Quality, Affordable Healthcare for All Americans

The final title in the act is the "Manager's Amendment," which includes amendments and additions to Titles I-IX, reflecting the unusual legislative process leading to passage of the ACA. Additional changes to Titles I-X were approved in a separate measure called the Health Care and Education Reconciliation Act (HCERA) signed into law by President Obama 1 week after he signed the base law on March 23, 2010. This title also reauthorizes the Indian Health Care Improvement Act, which provides healthcare to American Indians and Alaskan natives.

Contributor Information

John E. McDonough, DPh, MPA

Professor of Health Policy and Management

Harvard University School of Public Health

Boston, Massachusetts

John E. McDonough, DPh, MPA, has disclosed no relevant financial relationships.

TRichter · Aug 15, 2012

HI.

There are a lot of opinions here. The Accountable Care Act is trying to make medical care available for everyone, regardless of age or pre-existing conditions. As it stands, many people who have chronic illnesses cannot afford the insurance to help them recieve much needed treatment to prevent them from having to visit ER, and admissions.

Currently, Medicare has chosen large organizations and hospitals as Accountable Care Organizations. Their role is to try to "manage" and control cost for medicare patients who have straight medicare, which allows them to see any specialist any time they choose. Accountable Care Organizations (ACO) need to find ways to educate these patients on managing their care better and on their illnesses, allowing patients to manage their health much better than they are currently. IN so doing this, the thought is it will lower costs of care for these patients because they will learn how to stay healthy, and how to limit the tests and procedures they have. THis program is in it's infancy stage, so the ACOs are still trying to figure out the best way to help the Medicare patients. If they do figure it out, and lower the yearly costs spent on Health Care for these patients, this could "bench mark" new standards of care for all patients.

In no part of the ACA is there any stipulations on limiting care patients receive. It is limiting unnecessary items, or repeating things unnecessarily. I have friends who live in England, and their health care is in no way limited. They recieve great care, they just pay higher taxes. So instead of higher taxes, which AMerican's have voted against, the government has found a way to make insurance affordable for everyone.

I believe it is a win/win situation if we all work together. From what I understand, the only way Health Care providers, nurses and such will be directly effected would be in salary. We need to think about why we entered into this line of work.

cdsga · Aug 15, 2012

I got in this profession to care for people clinically-and to make enough money to provide for my family and myself. I did not get into this profession to drain myself, sacrifice my life and my livelihood to provide care to the masses. I don't make a lot of money, but enough to be able to provide basic needs. I am not a nun-I am not working for charity.

With the ever present expectation to get higher education, more money is required, more sacrifice is required, and there should be some way to compensate those who try to meet the basic requirements. There are many other ways to cut cost-in fact studies have shown time and again that it's the nurses who save the facilities money.

I don't appreciate the idea that this ACA can't sustain compensating experienced nurses and novice nurses by paying wages for nurses for years of experience, degrees earned, certifications, continuing education, travel. They want more NP's-they want more PhD's, well then make it affordable-with some return on the investment. When these higher degree nurses have their credentials, you can rest assured they will not be at the bedside. They've earned the right not to be there. It's the trenches where we need good experienced people to take care of the sicker and sicker patients-insured or not.

We have endured years where no raises were given, shortages-no relief in site (I remember the 80's), having to stay overtime while you had to arrange for childcare etc in your absence because you had to attend to sick people. We all have lives, not everyone lives in a big city, and no one should be burdened with guilt that you make a wage compensatory to your line of work. Lawyers and Doctors certainly don't. Insurance agents certainly don't. Why do we always have to have the guilt trip laid on us?

If the only way we will be directly effected is by salary-then you will see lots of nurses leave the profession-leaving a formidable shortage and novice nurses who have no idea what to do, how to cope and many who do not share the same level of duty as the old nurses have demonstrated.

It's going to be interesting.

ProgressiveActivist, BSN, RN · Aug 15, 2012

This is huge and we all need to become well informed.

Maybe the moderators will consider a separate forum for the implementation of the Federal Affordable Care Act.