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?
It is true. I have personally contemplated hiring someone who clearly understands this stuff to help me figure out my options. I am working 7 days a week and am still having to divide my budget for medical expenses into two categories:
1. That which is necessary and impacts immediate health and safety of the family.
2. That which is not necessary,(luxuries) such as sleep studies and cholesterol medicine
Specializes in NICU, PICU, Transport, L&D, Hospice.
It is true. I have personally contemplated hiring someone who clearly understands this stuff to help me figure out my options. I am working 7 days a week and am still having to divide my budget for medical expenses into two categories:
1. That which is necessary and impacts immediate health and safety of the family.
2. That which is not necessary,(luxuries) such as sleep studies and cholesterol medicine
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?
I do not know the answers to those questions but I do know that the costs in terms of copays have increased around the same time as ACA, so there is a direct correlation in my mind. I don't have hard data to prove it, but i do have documentation to prove this: last year was not the first time I was prescribed fenofibrate. I used to get it under the brand name tricor and the copay was 35 dollars. Also I was approved for a sleep study twice in the last ten years and never went through with it due to a personal fear of sleeping in a strange place. I regret that decision because I would like to go just because I think the intervention would make me feel better physically.
I'm not exactly sure why the copay for a brand name medicine was later more than double the copay for the generic version, and when the effectiveness of the medication was demonstrated, that medication was no longer even covered. I speculate it was related to the passing of the ACA, but who am I other than a working class individual posting an opinion in a chat room. I am not on television telling people who or what to vote for nor am I in Congress voting on any of this. Politically speaking I lean in neither direction. In fact I am registered as a Democrat, but I try to vote based on the candidates' qualifications for the position rather than party afiliation. I don't have an opinion on repealing the ACA, but I do want the entire situation to improve. That is all.
Also my employer and my enrollment in my plan has not changed since early 2009. The examples I referred to were post 2009 and the changes in my coverage were post 201
So to clarify. I took brand name tricor in 2010 with a 35 dollar copay. In 2013 fenofibrate cost me a 75 dollar copay and in 2014 it wasn't covered. My first hospital based sleep study was approved in 2005 so that doesn't count. The second hospital based sleep study was preapproved in 2010. I never scheduled either one. In 2014 I was denied both a hospital based one and an at-home one. My enrollment, to my knowledge, did not chang.
Specializes in NICU, PICU, Transport, L&D, Hospice.
I appreciate you candid responses.
Did your health insurance plan or rates ever change before the ACA? Since 2000 rate/cost hikes have been as low as 3% (2010) to more than 12% (2002).
The ACA required that health insurers cover some pretty standard medications. All health plans in a Marketplace must include prescription drug coverage, but each state sets the list of covered medicines, called the formulary. For instance, one plan may have many more medicines in one category or class than another state does. Even before the ACA it was wise to check your personal medication list against the formulary of the health insurance plan you were buying or considering.
It would be great if we had a single payer system so that you did not have to prioritize health concerns after things like food and shelter.
Maybe our Republican Congress will repeal the ACA and give us some Medicare for all.
To answer the first question there was an increase from 267 dollars per week to 298 dollars per week between 2010 and 2012. Maybe in anticipation of the ACA? I'm speculating. But you are correct I should have known to check the formulary. I need to for my clients in the community so why I didn't do that I don't know. Maybe just a tendency on my part to take care of everyone else first.
The major health concerns of the family I support come after food and shelter. My personal health unfortunately has become last. That is my choice. We are fortunate to hsve a roof over our heads and warm water to shower with. We do not have to endure the deplorable living conditions i see day to day in my work. We don't live a lavish lifestyle and that's ok. My children's clothes are all second hand unless they were gifts. My house is heated by wood. We fill the oil tank twice a year for hot water. My smartphone and laptop are reimbursed/paid for by my employer. The car my spouse drives is over 10 years old. My vehicle is newer, but a reliable all weather vehicle is an absolute necessity for my job. So we do enjoy some "luxuries" as compared to some of my patients residing in boarding houses and homeless shelters, but we are not exactly living the lifestyle I had envisioned 22 years ago when I enrolled in my four year nursing program either.
To answer the first question there was an increase from 267 dollars per week to 298 dollars per week between 2010 and 2012. Maybe in anticipation of the ACA? I'm speculating. But you are correct I should have known to check the formulary. I need to for my clients in the community so why I didn't do that I don't know. Maybe just a tendency on my part to take care of everyone else first.
Health insurance premiums have been steadily rising since long before the ACA. Your increase of about 5% per year is actually lower than the baseline of insurance premium inflation prior to the ACA.
Specializes in NICU, PICU, Transport, L&D, Hospice.
The major health concerns of the family I support come after food and shelter. My personal health unfortunately has become last. That is my choice. We are fortunate to hsve a roof over our heads and warm water to shower with. We do not have to endure the deplorable living conditions i see day to day in my work. We don't live a lavish lifestyle and that's ok. My children's clothes are all second hand unless they were gifts. My house is heated by wood. We fill the oil tank twice a year for hot water. My smartphone and laptop are reimbursed/paid for by my employer. The car my spouse drives is over 10 years old. My vehicle is newer, but a reliable all weather vehicle is an absolute necessity for my job. So we do enjoy some "luxuries" as compared to some of my patients residing in boarding houses and homeless shelters, but we are not exactly living the lifestyle I had envisioned 22 years ago when I enrolled in my four year nursing program either.
Imagine how much more difficult these health related decisions are for the working poor who have had no health insurance coverage in the past.
I worked in hospice for a good long time. I am acquainted with several males who died untimely deaths because their health came after the needs of their families. One poor guy routinely took half of his BP meds and few of his other meds because he couldn't afford them without insurance coverage AND still provide for his two teenaged daughters. So he experienced a life altering and ultimately life ending health event. His family suffered immensely in the many months that it took for him to finally die from his CVA.
Prior to the ACA, folks like him (and presumably like yourself) couldn't just get health insurance if it wasn't offered by their employer. He had a pre-existing condition and no plan available to him in the private marketplace was comprehensive or affordable enough to actually be a practical option. Prior to the ACA folks like him simply accessed care emergently that the hospitals were not reimbursed for. Now many of those folks have some coverage under the ACA so the hospitals have less nonreimbursed care.
The ACA is not great. But it did make the country reflect on the need to change our status quo in health insurance and health care delivery. What we had been doing is/was NOT sustainable.
SmithRNclassof97
31 Posts
It is true. I have personally contemplated hiring someone who clearly understands this stuff to help me figure out my options. I am working 7 days a week and am still having to divide my budget for medical expenses into two categories:
1. That which is necessary and impacts immediate health and safety of the family.
2. That which is not necessary,(luxuries) such as sleep studies and cholesterol medicine