Healthcare deductables

azhiker96, BSN, RN · Jan 28, 2015

Health insurance deductables are as high as health insurers can legally make them. That is and always has been true irrespective of the ACA.

I'm not sure how the deductibles before the ACA could have met the legal limit when there was none. In any case, deductibles for my insurance have roughly doubled to the new legal limit since passage of the ACA. That is the least of my worries.

My saftey net hospital has lost $50M/yr of disproportionate funding because those funds were eliminated by the ACA. In theory, everyone now has insurance. In practice, we still have just over 35% self/no pay. Our leadership is working with the state to try to find funding otherwise we have less than a year to go.

When someone comes in who doesn't have insurance, they are encouraged to sign up. However, we cannot force them and they know it. The exemptions from the tax/penalty are well known so that is NOT an incentive. Even a subsidised premium is still a premium that many choose not to pay.

fawnmarie, ASN · Jan 28, 2015

Condescending? What I find condescending is when individuals insinuate that anyone who supports the ACA is looking for a handout.

Did I vote for what Red Krypt cynically referred to as the "brave new world?" Absolutely, because as a nurse, I believe that every patient is entitled to quality care! One of the most outstanding examples of abuse by the health insurance industry that I can recall occurred when I was working in LTC. The same elderly gentlemen kept getting strep throat, in fact he had five confirmed cases of strep throat in one year's time. His insurance carrier refused to pay for him to have a tonsillectomy because he had not had SIX confirmed cases of strep throat in one year. I currently have an uninsured patient with hemiparesis from an MVA who needs physical and occupational therapy. Because of her uninsured status, she is being housed in a state hospital without appropriate resources. I have been without insurance myself, and I was a working student at the time, not someone seeking a "handout" or "something for nothing." The most condescending remarks about the ACA come from individuals whom have always had insurance and cannot begin to fathom how hard life can be for the less fortunate.

klone, MSN, RN · Jan 28, 2015

I'm not sure how the deductibles before the ACA could have met the legal limit when there was none. In any case, deductibles for my insurance have roughly doubled to the new legal limit since passage of the ACA. That is the least of my worries.
My saftey net hospital has lost $50M/yr of disproportionate funding because those funds were eliminated by the ACA. In theory, everyone now has insurance. .

Disproportionate funding was not eliminated. My facility still receives it. Not everyone is eligible for insurance under the ACA (eg: undocumented immigrants). Also, I believe Medicaid qualifies under disproportionate funding. Maybe if Jan Brewer weren't so crazy, your facility would still have its funding.

Edited to add: color me surprised! I just googled after posting this, and I see she voted for expansion. She's such an avowed Obama-hater I just assumed she didn't!

Red Kryptonite · Jan 28, 2015

fawnmarie, you know what they say about ASSumptions. I have lived through periods where I had no health insurance. But nice try.

As to Jan Brewer, yep she gave in to her shakes and opted for another hit from the federal pipe, but since the laws don't allow us to try truly market based solutions she didn't have much choice. She was right that it would be throwing away needed money (that Arizona paid in) for no real reason.

toomuchbaloney · Jan 28, 2015

I'm not sure how the deductibles before the ACA could have met the legal limit when there was none. In any case, deductibles for my insurance have roughly doubled to the new legal limit since passage of the ACA. That is the least of my worries.
.

My point was not that there was or is a law, but rather that the insurance industry will charge whatever fees and rates they believe they can and will raise those rates whenever they believe that they can. Their objective is to make money, as much as possible, they do this by gambling in healthcare.

toomuchbaloney · Jan 28, 2015

fawnmarie, you know what they say about ASSumptions. I have lived through periods where I had no health insurance. But nice try.
As to Jan Brewer, yep she gave in to her shakes and opted for another hit from the federal pipe, but since the laws don't allow us to try truly market based solutions she didn't have much choice. She was right that it would be throwing away needed money (that Arizona paid in) for no real reason.

I don't believe that fawnmarie was specifically addressing you when she wrote

The most condescending remarks about the ACA come from individuals whom have always had insurance and cannot begin to fathom how hard life can be for the less fortunate.

Unless you believe that yours are some of the most condescending remarks about the ACA. She merely referenced your use of the "Brave New World" terminology earlier in the post.

MunoRN, RN · Jan 28, 2015

fawnmarie, you know what they say about ASSumptions. I have lived through periods where I had no health insurance. But nice try.
As to Jan Brewer, yep she gave in to her shakes and opted for another hit from the federal pipe, but since the laws don't allow us to try truly market based solutions she didn't have much choice. She was right that it would be throwing away needed money (that Arizona paid in) for no real reason.

What sort of "truly market based solutions" are you referring to?

Red Kryptonite · Jan 29, 2015

Here's a short description with an attached detailed policy statement that represents moves in the right direction.

Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

toomuchbaloney · Jan 29, 2015

Here's a short description with an attached detailed policy statement that represents moves in the right direction.
Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

So a truly market based health care system utilizes block grants, vouchers, and health savings accounts? These things will fix what is broken with the US health care system?

allnurses Guide · Jan 29, 2015

Here's a short description with an attached detailed policy statement that represents moves in the right direction.
Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

I like to read opinions from the Cato Institute. Sometimes I agree with them. This time I got this far:

First, Congress should give Medicare enrollees a voucher and the freedom to choose any health plan on the market. Vouchers would be means-tested, would contain Medicare spending, and are the only way to protect seniors from government rationing...
Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

I have had Medicare for several years. My husband began using Medicare as his health insurance when he turned 65 in 1992.

At first he was quite health,as am I. He saw our physician once a year, got prescriptions for medication for his hypertension and was fine. He began having more health problems in his 80s.

We get excellent care with Medicare with less paperwork. For a while in the 1990s my employer healthcare was PacifiCare. That plan required authorization to see a specialist. It took two weeks for that. Once my shoulder was injured. I had terrible pain that actually brought me to my knees. I couldn't straighten or raise my arm. There was a 2 week wait for the insurance to authorize my seeing an orthopedic physician, another 2 weeks for an MRI, and another 2 weeks for authorization to go back to the orthopod, and another for authorization to start physical therapy.

When a car hit my husbands bicycle there was no problem seeing the appropriate doctors and having ordered tests because he had Medicare.

We pay monthly for a Medicare supplement. The supplement pays the 20% that Medicare does not. So far even then that amount has always been less that the monthly premium so the company uses most of our premium to keep paying millions of dollars to the CEO.

I sure hope we are never in need of such expensive care.

I remember before Medicare when families had to pay hospital bills for their grandparents whose savings had run out. They were the generation who raised their kids during the Great Depression and then fought WWII.

I don't know of Medicare rationing needed care.

I don't like the affordable care act because our tax money goes to for profit companies that have a history of rationing and denying healthcare. But had to explain that I have never known of Medicare rationing the care for seniors.

(I HAVE heard politicians suggest such rationing for decades)

PS: Here is the full policy analysis:

http://object.cato.org/sites/cato.org/files/pubs/pdf/pa650.pdf

MunoRN, RN · Jan 29, 2015

Here's a short description with an attached detailed policy statement that represents moves in the right direction.
Yes, Mr. President: A Free Market Can Fix Health Care | Cato Institute

From the article:

First, Congress should give Medicare enrollees a voucher and the freedom to choose any health plan on the market. Vouchers would be means-tested, would contain Medicare spending, and are the only way to protect seniors from government rationing.

Medicare enrollees already have the option to buy a plan administered by a private insurer, they're called medicare advantage, and cost significantly more than traditional medicare coverage.

Second, to give workers control over their health care dollars, Congress should reform the tax treatment of health care with largeâ€ health savings accounts. Large HSAs would reduce the number of uninsured Americans, would free workers to purchase secure health coverage from any source, and would effectively give workers a $9.7 trillion tax cut without increasing the federal budget deficit.

HSA contributions are already tax free. Anyone can save as much as they want for healthcare expenses, making the amount of that which is tax free does nothing for those without the ability to both pay their high-cost risks through insurance and put away large amounts on top of that. Basically, this only helps healthy people with lots of money, and leaves far less money available to treat the chronically ill, making the potential for true rationing far more likely.

Third, Congress should break up state monopolies on insurance and clinician licensing. Allowing consumers to purchase health insurance licensed by other states could cover one-third of the uninsured without any new taxes or government subsidies.

There are already multi-state plans available on the exchanges, although those plans must meet the regulatory requirements in each state they operate in. Obamacare does allow for multiple states to enter into insurance compacts, which set up a single regulatory process allowing consumers to buy the same plan across state lines. The Arizona legislatures voted to join one of these compacts which was then vetoed by Jan Brewer, claiming it was a threat to individual states rights. This is a common stance among conservatives, that regulating plans should be controlled by individual states, which is what stands in the way of buying plans across state lines.

Finally, Congress should reform Medicaid and the State Children's Health Insurance Program the way it reformed welfare in 1996. Block-granting those programs would reduce the deficit and encourage states to target resources to the truly needy.

"Block granting" is just another way of saying "rationing". Basically what block granting does is it sets a fixed amount at the beginning of the year to spend on children's healthcare, if that limit is reached after only 6 months then either nobody gets paid for providing care for the other 6 months, or they just don't provide healthcare for the other 6 months. There is nothing about block granting that makes the actual care less expensive, so all it does is reduce the amount of care it's paying for. So if your kid needs life saving surgery, if they need it january then you're in luck, if they need it in september then too bad.

toomuchbaloney · Jan 29, 2015

I am anxious to hear the plans for replacing important elements of the ACA once Boehner et al repeal it.