Obamacare and Nursing.. what do you think? - page 5

by OKNurse2be

I know that I am possibly opening up a can of ugly worms. I hope that in spite of differing opinions, that this thread can remain friendly and a simple exchange of ideas and opinions. As a beginning nursing student, I am... Read More


  1. 0
    I pray for the people who will visit the ED that opts for uncomfortable stretchers and nothing but bread and water...
  2. 6
    I wanted to respond to the comment regarding Medicare recipients "abusing" the ER...Medicaid has a requirement of what can be seen in the ER, or they will have to foot the bill, FYI...that has been in place for a while. So the people that you speak of continue to stack bills that are unpaid, mainly because, if anyone on here has been on government assistance, especially Medicaid, you don't go to a PCP...a lot if times you are forced to go to subpar "health clinics," sometimes for repeated visits, which can be a challenge for someone who works but are qualified for Medicaid. As for being in Medicare, you have a MUCH more broader scope of getting higher quality of care, especially if you are disabled or elderly.

    Having experienced a significant medical setback, I was on Medicaid, was dropped once I got SSDI, and waited two years to résumé treatments until I was Medicare eligible. That was
    physically and emotionally draining.

    There are MILLIONS of people that undergo this physical and emotionally daring situation every day....I have seen countless individuals and families make these decisions...without those social programs, they would've been bankrupt.

    Most people are not FOR something, especially social issues regarding the "less fortunate" until it happens to THEM, and then they are still upset. I RATHER have that not happen at ALL.

    Another poster stated the obvious; hospitals WILL emphatically make more money because of ACA...more people will be covered, as well as insurance has 90 days of hospital coverage, and can be negotiated past the 90 days as well...Hospitals are craving the insurance; I believe most hospitals would prefer the insurance cash flow than the CMS money...When I was a pt during my own medical crisis, they were VERY happy to have me. If I wanted to, I could've extended my hospital stay for a week, I said "no thanks!" (I was there a total of 11 days). Also, CMS has been implementing reimbursement and hospital funding to include nursing care...the more insured, the more money in the hospital pockets, less worries of CMS enforcement.

    I am sure there will be a very happy medium for the ACA. More insurance, more jobs for nursing-in hospitals and in the insurance industry; people with chronic health conditions, excluding the elderly; I'm talking 19-59, will have access to healthcare, increasing their ability to work.

    I think our country's rich culture of fear-mongering is making the effectiveness of the program. I am on our country's side of allowing us to be logical free thinkers. ACA will work, and if it needs tweaking, then it will be tweaked.

    I know people who were on the committee, there were doctors and nurses in my area who reported what underserved populations they cares for, the barriers, the concerns of hospital economics, etc. They were at the table. They don't want the hospitals to drive down our wages because of the in flux of new patients; they also wanted to make sure that there will be broader reimbursement and funding for nursing care (this is included in ACA). All those concerns were included. I was able to go through the arduous bill, and also read the entire transcript of the SCOTUS decision. I am informed enough to be supportive of a framework that can be built on, modified, but can start to benefit so many people. I have been on the nefarious side of having no insurance as I stated before. I'm ALL for the ACA act.
    salvadordolly, NRSKarenRN, SuzieVN, and 3 others like this.
  3. 0
    Quote from LadyFree28
    I wanted to respond to the comment regarding Medicare recipients "abusing" the ER...Medicaid has a requirement of what can be seen in the ER, or they will have to foot the bill, FYI...that has been in place for a while. So the people that you speak of continue to stack bills that are unpaid, mainly because, if anyone on here has been on government assistance, especially Medicaid, you don't go to a PCP...a lot if times you are forced to go to subpar "health clinics," sometimes for repeated visits, which can be a challenge for someone who works but are qualified for Medicaid. As for being in Medicare, you have a MUCH more broader scope of getting higher quality of care, especially if you are disabled or elderly.
    .
    Actually, there are several facts in this reply that are incorrect. First, Medicaid is structured so that the majority of healthcare reimbursements come from the state level as managed care organizations, or MCOs. Depending on the specific MCO that a Medicaid recipient elects, that MCO is responsible for administering plan specifics and covered services. I'm not certain where you're located and if things are done differently there, but here in Maryland MCOs like Amerigroup, Jai Health, and Priority Partners actually require Medicaid recipients to elect a primary care provider upon enrollment with the expectation that the PCP is the provider to address non-emergency health conditions. As a matter of fact, that PCP is printed on the medical assistance card, and the patient has to utilize their PCP's services in order to obtain any specialty referrals. I don't know what kind of Medicaid clinic you're referring to, but almost all of the healthcare providers around here who accept medical assistance also accept private insurances.... I can say with absolute 100% certainty based upon my experience as a Baltimore inner city ED nurse that a large percentage of the ESI 4s and 5s (most of which have medical assistance, FYI) that come through the door aren't emergencies by any stretch of the imagination. I'm talking about runny noses x 1 day but afebrile; tooth pain in the same person for the fifth time, but patient never f/u with a dentist; monthly STD prophylaxis in some of Baltimore's finest "working girls"; knee pain in morbidly obese patient x 1 year with no change in Sxs, but patient admits that they just need a work note; a 19 year old brought in by ambo for a UTI because "it hurts when I pee". Hmm... remind me how that's not absolute blatant abuse of emergency department resources. Yet all of these people continue receiving treatment in the ED. I can assure you that's not because of any supposed eligibility criterion that MCOs have developed, let alone enforced in the past. I'm all for medical assistance setting coverage limits regarding inappropriate use of emergency services, but I can assure you that at least around these parts, that's definitely not the case.
  4. 0
    Quote from XmasShopperRN

    Actually, there are several facts in this reply that are incorrect. First, Medicaid is structured so that the majority of healthcare reimbursements come from the state level as managed care organizations, or MCOs. Depending on the specific MCO that a Medicaid recipient elects, that MCO is responsible for administering plan specifics and covered services. I'm not certain where you're located and if things are done differently there, but here in Maryland MCOs like Amerigroup, Jai Health, and Priority Partners actually require Medicaid recipients to elect a primary care provider upon enrollment with the expectation that the PCP is the provider to address non-emergency health conditions. As a matter of fact, that PCP is printed on the medical assistance card, and the patient has to utilize their PCP's services in order to obtain any specialty referrals. I don't know what kind of Medicaid clinic you're referring to, but almost all of the healthcare providers around here who accept medical assistance also accept private insurances.... I can say with absolute 100% certainty based upon my experience as a Baltimore inner city ED nurse that a large percentage of the ESI 4s and 5s (most of which have medical assistance, FYI) that come through the door aren't emergencies by any stretch of the imagination. I'm talking about runny noses x 1 day but afebrile; tooth pain in the same person for the fifth time, but patient never f/u with a dentist; monthly STD prophylaxis in some of Baltimore's finest "working girls"; knee pain in morbidly obese patient x 1 year with no change in Sxs, but patient admits that they just need a work note; a 19 year old brought in by ambo for a UTI because "it hurts when I pee". Hmm... remind me how that's not absolute blatant abuse of emergency department resources. Yet all of these people continue receiving treatment in the ED. I can assure you that's not because of any supposed eligibility criterion that MCOs have developed, let alone enforced in the past. I'm all for medical assistance setting coverage limits regarding inappropriate use of emergency services, but I can assure you that at least around these parts, that's definitely not the case.
    I was responding about how it is run in MY state; I am VERY much aware of how MCOs are run. I have chart reviewed for CMS, and best believe, they RECODE and strive to NOT cover.

    Now, back to MY area, MY state.

    Drs have stopped taking certain MCOs that have Medicaid; each MCO has a variety of products; Medicaid, Medicare, employee, private/individual. They negotiate the pay within Drs and Hospital-Afilliated networks. There is a HUGE MCO that had a lawsuit with several hospitals in my area years ago when I had Medicare during my significant event in which they did not want to cover people who were low income; I was almost in limbo with the continuation if my care. Currently, most recipients who have this particular insurance enjoy the preventive benefits...BUT will have to foot the bill for low level ETMLA visits; if it is NOT trauma related, or life or death, they are NOT converting it. They recently sent a letter from the STATE stating they WILL NOT cover ED visits that DO NOT QUALIFY; and recipients now will have to look at a LIST. They CANNOT see these particular Drs anymore. Those people YOU see in your area will get a bill in MY AREA.

    A lot of people with this insurance go to "clinics,"
    not private practices...My own doctor stopped taking it because they were affiliated with a hospital that was a part of a larger care network.
    I was relieved I was not on the plan when they made that change.

    If it sounds flawed, don't blame the messenger...that's how they do business in MY state...
  5. 5
    Quote from lossforimagination
    Have you seen how much insurance premiums are going up due to Obamacare?6.3% Health Premium Increases Projected for 2013
    Fortunately, my premium didn't rise at all this year. In previous years, it had gone up 10% every year. In 2007, when Dubya was still in office, my health insurance premium went up 3 times in 1 year. What was the excuse then?

    Insurance companies have been raising premiums every year for years, they just blame Obamacare now.
    shouldI, Amnesty, SuzieVN, and 2 others like this.
  6. 4
    Quote from Not_A_Hat_Person

    Fortunately, my premium didn't rise at all this year. In previous years, it had gone up 10% every year. In 2007, when Dubya was still in office, my health insurance premium went up 3 times in 1 year. What was the excuse then?

    Insurance companies have been raising premiums every year for years, they just blame Obamacare now.
    ^This...

    Same thing happened to me as well. when Dubya was in office, My insurance premium was raised two times TWO years in a row. And I was paying INDIVIDUAL insurance, ie FULL cost insurance. This year, I got money back from my insurance company and my prescriptions went down...because of Obamacare. I can't argue against the benefits of it.

    It gets REAL easy to scapegoat "Obamacare" when the practices that insurance companies have been doing for years gets noticed by the public...but noticed by people who either pay out of pocket, or pay attention to their health insurance premiums. It is also a great tactic that people (that includes corporations now, because they are people too, according to the Citizens United ruling) use...scapegoating, blame, shame, guilt, all so they can keep doing what they are doing without accountability...
    shouldI, tewdles, Not_A_Hat_Person, and 1 other like this.
  7. 3
    Does the President really have that much (sole) power over us? The media has apparently done its jobs quite well, because (too) many in the US believe that such is the case. Here is a somewhat off-topic example of presidential influence on us:

    My first marriage began in 1976 and ended in 1983... who was President during those years? I should blame them for both the marriage and its failure. I married again in 1990. Who was president in 1990 and who is President now? I should (again, in the spirit of placing my fate in the hands of whoever is President) assign credit to whoever was President during those years. The same could be said for jobs... my current (and probably best) job began While G.W. Bush ("Bush, Junior", for those in Rio Linda) was President, so I will credit him with that. I am currently employed in that job, and Obama is President, so I should credit Him with that.

    Sound ridiculous? You betcha!

    Our society has been well trained to mostly ignore the rest of those we elect (i.e., hire) to represent us. We vote for somebody (locally, regionally, and nationally) because he is of the proper political party, he is spoken well of (and frequently) frequently on ___ News, he promises us all sorts of stuff, and/or he tells us how bad the other candidate is/was. That he lies to us does not matter, as he still meets the aforementioned requirements. We have our favorite sports teams, political parties, and politicians, so much so that we, as a society, become dependent upon those elected officials to be our leaders and to take care of us. We look down our noses at those who are of the other party and those who watch the other news network or read the other newspaper.

    Until this changes, nothing will change.
    JeanettePNP, tewdles, and laborer like this.
  8. 0
    Quote from Not_A_Hat_Person
    Fortunately, my premium didn't rise at all this year. In previous years, it had gone up 10% every year. In 2007, when Dubya was still in office, my health insurance premium went up 3 times in 1 year. What was the excuse then?

    Insurance companies have been raising premiums every year for years, they just blame Obamacare now.
    I don't blame Obamacare. I'm just wondering why premiums haven't decreased like he promised, and why people keep believing in his promises.
  9. 0
    Quote from SC_RNDude
    I don't blame Obamacare. I'm just wondering why premiums haven't decreased like he promised, and why people keep believing in his promises.

    Please provide a 'single' quote from Obama, in which he said anything about decreased premiums. Premiums are going to skyrocket. This is fact.
  10. 0
    Blame the insurance lobby first...


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