How has Obamacare affected you and your employer?

[ProgressiveThinking]

I'm scheduled to start in a private ED hospital next month. I started at a VA on a PCU unit as a new grad, but I feel like I'm depriving myself of the experience I desire.

As I consider transitioning from a highly political, but stable federal hospital (VA) to a private hospital in order to gain the ED experience that I desire (a broader pt population-not just older vets in for pain med refills and jock itch), I ask myself how the ACA has affected your employer (hospital, school, prison, etc.). Have budgets been cut? Have layoffs taken place (specifically nurses being laid off)? Are you called off less or more? Have PRN positions been eliminated or increased? Is agency/travel used more? Have your benefits been affected? Have your employers anticipated any forthcoming changes?

Please share!

[wirehead]

Hi SmithRN,

Great post. I too work in home care, and what KILLS me is how a patient on Medicaid can get unlimited amounts of wound care supplies/dressings while Medicare patients, many who are war veterans, cannot!!! They've paid into the system, worked most of their lives and they get the shaft! Insane stuff!!

I would like to express an opinion and this is a personal opinion not a political one. As a home care nurse I am happy for my patients who are able to obtain services and seem to have more choices in finding good community providers. I feeling a little jealous at times that $300 dollars a week is taken from my paycheck to pay for my private plan. I know the employer kicks in quite a bit too, hence the "benefit" of full time employment. What gets me is that the patients I see are getting medication and diagnostic tests that my private plan consistently denies payment for. I am working full time just for the health insurance. I could make just as much money working per diem with much less headaches.

[wirehead]

No doubt the ACA has raised premiums, I can give you an actual example affecting my family. Prior to the passing of the ACA, my sister had a BC/BS EPO plan that fit her needs and cost $198 per month, no in-network deductibles, and $20 co-pays. Since the ACA, that plan has steadily risen and benefits have decreased significantly, the same plan now costs her $466 monthly with a $2,500 in-network deductible, and $40 co-pays. Needless to say, she's dropped her insurance, and will deal with the cruel penalty because it she simply can't afford it as a single mother.

My other sister faced a similar scenario, she and her spouse had another BC/BC product that was in the $400 per month range, their monthly premium jumped to over $1,000 per month with in-network deductibles, they too are now uninsured. I'm sure this is a common theme among many of our friends and family. I'd like to see the ACA reformed, it's too late for repeal, keep the good parts, lose the bad, open up the playing field to allow out of state companies to compete, and target Medicare/Medicaid fraud, and tort reform.

Do you feel that your troubles with health insurers is directly related to the ACA? Do you believe that your health insurance coverage would be more comprehensive and affordable had the ACA not been passed? Do you believe that your health insurance coverage will improve if the Congress repeals the ACA?

[SmithRNclassof97]

What you describe is very similar to what I see with the mentally ill out in the community. I had high hopes that the ACA would improve access to mental health services but it hasn't. The situation has become worse and I know that it is not because of the ACA but because of the state run system. Years ago all of my patients, or people suffering from the same conditions, were cared for in state run institutions. The safety of a locked hospital unit was replaced with a bug infested room in a boarding house and a nurse who visits twice daily to check on mental status, safety and administer medications. This seemed to work for a while and many stabilized with a consistent routine and med regime. In 2009, 2010 or so the twice daily services were pretty much authorized with a general statement showing there has been no change with the client but that services remained necessary in order to ensure personal and community safety. Over the last 3 years it has become increasing difficult to get twice daily services for anyone, no matter how psychotic. We are being forced to reduce services to once daily and we are expected to consult with the doctor regarding either a change in dosing or a change in medication to facilitate once daily visits, not to improve the client's mental health, but to save money. I have seen this result in tremendous de-stabilization among the mentally ill out there. Now the client's are more psychotic at baseline due to the change in medication or not having a therapeutic blood level. The mental health system is severely flawed, it was before the ACA, and it is worse now. Sadly, no one seems to care until there is a mass shooting somewhere. When that happens people talk about how mental health services needs to improve, then the topic is changed to gun control, then it is eventually forgotten.

[emtb2rn, BSN, RN, EMT-B]

I don't think it is so much the length of this document that makes it a daunting task to read, rather the language used to write it. The average person who has passed the 5th grade can easily read two Harry potter books. I don't think the average college graduate could get through that convoluted mess and fully understand it.

Didn't mean to like this (where's the undo button?)

Don't know if you ever noticed but virtually all legislation is written in a verbose and circumferential style that utilizes flowery language which obfuscates the plain meaning of what is intended.

[toomuchbaloney]

Didn't mean to like this (where's the undo button?)

Don't know if you ever noticed but virtually all legislation is written in a verbose and circumferential style that utilizes flowery language which obfuscates the plain meaning of what is intended.

Have you ever noticed that this is one of the hallmarks of people who are trained as attorneys. They are committed to writing things in a fashion which requires them to INTERPRET the writing for others. It helps them to create their own job security. Legalese ought to be disallowed and criminalized.

[MunoRN, RN]

No doubt the ACA has raised premiums, I can give you an actual example affecting my family. Prior to the passing of the ACA, my sister had a BC/BS EPO plan that fit her needs and cost $198 per month, no in-network deductibles, and $20 co-pays. Since the ACA, that plan has steadily risen and benefits have decreased significantly, the same plan now costs her $466 monthly with a $2,500 in-network deductible, and $40 co-pays. Needless to say, she's dropped her insurance, and will deal with the cruel penalty because it she simply can't afford it as a single mother.

Insurance premiums have actually been rising every year long before the ACA. If she gets no assistance in buying insurance then she makes at least $50k a year with one kid, $70k if she has two which is hardly poor. Are you arguing that the subsidies should apply to those who make more than that?

My other sister faced a similar scenario, she and her spouse had another BC/BC product that was in the $400 per month range, their monthly premium jumped to over $1,000 per month with in-network deductibles, they too are now uninsured. I'm sure this is a common theme among many of our friends and family.

The average cost of a employer provided plan before the ACA was $14k/year. People in the individual market paid significantly less than that; not because the same insurance was cheaper in the individual market but because it wasn't really insurance. A congressional hearing with 4 major insurance carriers found that in the individual market one out of every 7 claims was being denied, primarily big ticket claims (the main reason for having insurance) and that only reflects things these plans actually covered, which often didn't include hospitalizations. If plans in the individual market were really comparable to "true" insurance, why was it so much cheaper?

I'd like to see the ACA reformed, it's too late for repeal, keep the good parts, lose the bad, open up the playing field to allow out of state companies to compete, and target Medicare/Medicaid fraud, and tort reform.

The ACA already allows out of state companies to compete. "Multi-state" plans are available on the exchanges and the ACA also sets up the framework for multi-state compacts that allow plans to go through a single approval process for multiple state regulator approval. Targeting medicare/medicaid fraud is actually how most of the offsetting savings for the subsidies come from, which conservatives have been very critical of, characterizing fraud reduction as "cuts to medicare".

[smartnurse1982]

Hi They've paid into the system, worked most of their lives and they get the shaft! Insane stuff!!

That is only partially true.

They paid into the system,but i am 100% sure the $$$ they paid into the system has long dried up.

The working people who work now are paying for their healthcare needs.

Nothing wrong with it but just clarifying.

Btw,some of those poor people with everything pay taxes too.