My obamacare experience

Specialties NP

Published

I work in a state that elected to provide medicaid expansion as part of the ACA. We were closed yesterday for New Year's, so today was when "obamacare" implementation really took effect for my clinic.

Instead of seeing

My schedule for the next 3 weeks is booked entirely with established patients who need new referrals placed to the medicaid system. I am trying to clear a 2-year backlog of orders for echo's, ultrasounds, CTs, MRIs, physical therapy, and any specialty referral to rheumatology, urology, sports medicine, orthopedics, pain management, etc.

.... Yes, our patients previously waited, on average, more than 12 months for any of the above referrals. Without insurance we can only refer to the horrendously overbooked safety net county system. It was hopeless. Usually they never got any appointment at all. The alternative is a 24+ hour ER wait which rarely gets them the evaluation needed (an angry resident once returned a patient to me with WE DONT DO MRIs IN THE ER scrawled on the referral I gave her.)

I was finally able to order diabetic shoes and a wheelchair. Tomorrow I will see 2 asthmatics who need prescriptions for neb machines.

I will complete prior auth's for cellcept (SLE) and rebif (MS). Both patients are currently off meds due to cost and not doing well.

For patients with no insurance we have a very small dispensary with limited stock of meds. With medicaid coverage, I can now prescribe:

combined BP pills, januvia, finasteride, flomax, epipens, advair, imitrex, fioricet, insulin pens, namenda, aricept, lexapro, lipitor, lovenox, verapamil, zyrtec, olmesartan, atropine nasal, levaquin, and valtrex to name a few. I have missed lexapro and verapamil the most.

My experience with obamacare is that it has made me feel like SUPER NP!!! :up: because I can finally deliver care to high-risk patients. These are not bad people, or freeloaders, or "welfare queens." The majority of my patients are the working poor, who put in more hours/week than I do, feed more mouths, have more chronic diseases, and make a fraction of my salary. They keep my city running.

Has anyone else seen a dramatic change in their practice with ACA implementation?

Health care for all

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Specializes in FNP, ONP.

It is going to take a few years for the real impact to be clear. Some will be worse off, probably. The question is will it serve the greater good. Will more people be better off with advent of the ACA? We will have to compare 2020 statistics with 2010 statistics for a debate worth having. If the answer is no, will the country then be willing to consider moving forward toward a single payer system, or will the move even further backward into the abyss that has been 3rd party market place driven health care for profit?

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Specializes in ICU.

Why should healthcare be a God given right? That's the problem with America, everyone thinks they are entitled to everything. No, your not. You need to work for what you have. People think that they are entitled to everything and only the people who are rich should pay for it. Unless you physically cannot work (which healthcare is provided for those people), get up off your butt and get a job. But it's a recession and there are no jobs, people proclaim. There are plenty of jobs out there for people who want them. It may not be your dream job, but do it until a better one comes along.

We are being clobbered with extra taxes, now subpar healthcare, among many other things because people feel a sense of entitlement. They feel the rest of us should pay for their existence. And everything I have worked so hard for is going down the tubes.

People who feel this way need to move to a communist nation where everything is provided for but they have no human rights. You can't have both. Ask the people in China or North Korea what they would rather have freedom or free healthcare. I bet most of them say freedom.

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Specializes in LTC.
Why should healthcare be a God given right? That's the problem with America everyone thinks they are entitled to everything. No, your not. You need to work for what you have.[/quote']

Should a Type One diabetic be allowed to die because of inability to pay for insulin? Should a cancer patient die because of inability to pay for treatment? No human should die because they can't aide in the profit of a pharmaceutical company. Lifesaving medication and treatment should be a human right. Nobody should die from a treatable condition. Nobody.

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Should a Type One diabetic be allowed to die because of inability to pay for insulin? Should a cancer patient die because of inability to pay for treatment? No human should die because they can't aide in the profit of a pharmaceutical company. Lifesaving medication and treatment should be a human right. Nobody should die from a treatable condition. Nobody.

^^^^ this! Exactly. Kind of scary to see how anyone in the medical profession could think otherwise.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Why should healthcare be a God given right?

Irrelevant. If health was a God-given right then God would have created people who didn't get sick wouldn't he.

That's the problem with America, everyone thinks they are entitled to everything. No, your not. You need to work for what you have. People think that they are entitled to everything and only the people who are rich should pay for it. Unless you physically cannot work (which healthcare is provided for those people), get up off your butt and get a job. But it's a recession and there are no jobs, people proclaim. There are plenty of jobs out there for people who want them. It may not be your dream job, but do it until a better one comes along.

We are being clobbered with extra taxes, now subpar healthcare, among many other things because people feel a sense of entitlement. They feel the rest of us should pay for their existence. And everything I have worked so hard for is going down the tubes.

People who feel this way need to move to a communist nation where everything is provided for but they have no human rights. You can't have both. Ask the people in China or North Korea what they would rather have freedom or free healthcare. I bet most of them say freedom

I suppose the irony of coming on here first with your anti business, anti entrepreneur, views then telling US to move to a communist country is lost on you?

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Specializes in ER.

Healthcare provided by the government isn't really a constitutional, or God-given right. That doesn't mean that we shouldn't, as a nation, decide that we want to provide it.

Having people die in the street, having children go without care, letting people starve, I don't really think that's where we want our society to go. We are a civilized nation and an ethical one, for all our flaws. We elect people to represent us, to organize society, to protect the helpless, to provide infrastructure to allow us to work, and recreate. Why can't we also try to improve our healthcare system? It wasn't working well previously.

Having said that, I am still skeptical about Obamacare. I think there are superior systems out there, that it was put together poorly, and has many many flaws. But, the goals are valid ones.

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Why should healthcare be a God given right? That's the problem with America, everyone thinks they are entitled to everything. No, your not. You need to work for what you have. People think that they are entitled to everything and only the people who are rich should pay for it. Unless you physically cannot work (which healthcare is provided for those people), get up off your butt and get a job. But it's a recession and there are no jobs, people proclaim. There are plenty of jobs out there for people who want them. It may not be your dream job, but do it until a better one comes along.

We are being clobbered with extra taxes, now subpar healthcare, among many other things because people feel a sense of entitlement. They feel the rest of us should pay for their existence. And everything I have worked so hard for is going down the tubes.

People who feel this way need to move to a communist nation where everything is provided for but they have no human rights. You can't have both. Ask the people in China or North Korea what they would rather have freedom or free healthcare. I bet most of them say freedom.

There are many first world countries like England and Australia with healthcare for all and people have human rights. There are many rich people who suddenly become bankrupt because they got diagnosed with a very expensive disease. Many people do not understand healthcare until they are affected on a personal level. Obama care is not perfect. Our premiums as a family are way higher this year. Would I rather be paying higher premiums or be that person with a debilitating disease that makes my provider wonder if am still alive? I choose the former. It's unfair to claim that every one without insurance is lazy and doesn't work. Not many people getting paid 7dollars an hour are able to meet basic needs and still have health insurance.

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Specializes in Psych.

Apologies, see my post below.

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Specializes in Psych.
Why should healthcare be a God given right? That's the problem with America, everyone thinks they are entitled to everything. No, your not. You need to work for what you have. People think that they are entitled to everything and only the people who are rich should pay for it. Unless you physically cannot work (which healthcare is provided for those people), get up off your butt and get a job. But it's a recession and there are no jobs, people proclaim. There are plenty of jobs out there for people who want them. It may not be your dream job, but do it until a better one comes along.

We are being clobbered with extra taxes, now subpar healthcare, among many other things because people feel a sense of entitlement. They feel the rest of us should pay for their existence. And everything I have worked so hard for is going down the tubes.

People who feel this way need to move to a communist nation where everything is provided for but they have no human rights. You can't have both. Ask the people in China or North Korea what they would rather have freedom or free healthcare. I bet most of them say freedom.

What an irrational argument. Compare apples to apples: the US has the most unjust healthcare system in the OECD. My goodness leave the extremism out of the argument as it is just plain silly.

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Specializes in Mental Health.
As a supporter of healthcare for all,which should be a God given right to everyone born in this the richest and most powerful nation on the face of this earth I have a big concern.That deductibles set by insurance companies and our government will be detrimental to this version of ACA being successful.Working class people who scrape together the monthly premium will be in for a rude awakening trying to pay the high deductibles before the insurance will pay a dime.I personally feel that this will hopefully

push our country to Universal Coverage similar to Medicare or the European model of care for ball

Let's hope.

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Healthcare provided by the government isn't really a constitutional, or God-given right. That doesn't mean that we shouldn't, as a nation, decide that we want to provide it.

Having people die in the street, having children go without care, letting people starve, I don't really think that's where we want our society to go. We are a civilized nation and an ethical one, for all our flaws. We elect people to represent us, to organize society, to protect the helpless, to provide infrastructure to allow us to work, and recreate. Why can't we also try to improve our healthcare system? It wasn't working well previously.

Having said that, I am still skeptical about Obamacare. I think there are superior systems out there, that it was put together poorly, and has many many flaws. But, the goals are valid ones.

I couldn't agree with you more! :yes:

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