New health care laws and our jobs.

  1. Hi everyone, LPN here from the midwest. I just had a meeting at work and heard that because of medicare cuts they may have to cut back on census and thus cut back on employees. They havent mentioned it but I think there also going to run into trouble with the fact that the new laws require any business of 50 or more employees is REQUIRED to provide health insurance to it's employees. My place of work does not provide benefits its a small town for profit facility. We DO have like exactly 50 employees. So yea, im guessing the fact that there gonna be required to provide us insurance is another reason why they might have to cut back. Its kinda scaring me though, im beginning to wonder what might happen. Right now nursing and CNA work is one place where you are always able to find a job. Is that going to change and all the sudden it will be tough to find places to work because facilities will start cutting down on staff and residents? Where will those residents go anyway?
    I probably just started a political argument, but im really not interested in the bickering between the right and the left right now. The laws been passed and im just wanting to know what we are stuck with. Id like a more non partisan discussion. Unbiased facts. Not looking for blame games like "the liberals are ruining us" or "the redneck conservatives dont know whats good for them". Looking for intellegent responses id rather not anyone bother talking like they do in congress, fox, or msnbc. From my point of view, both sides have good points, but when one side is correct the other side just refuses to recognize this.
    Anyway... tell me what you all think? Whats going to happen to our jobs when it comes to nursing and healthcare?
  2. Visit roreyn02 profile page

    About roreyn02

    Joined: Sep '12; Posts: 14; Likes: 3
    LPN working as Nurse aid; from US
    Specialty: Nurse aid, some LPN clinicals


  3. by   Orca
    Honestly, there is a lot of uncertainty about how the new laws are going to work and also some misinformation being passed around. As a result, there has been a lot of overreaction to the new health care laws, and flippant statements by many managers about being forced to lay off employees, or not hire new ones, as a result of it without them fully understanding it.

    The truth is, no one really knows how all this is going to shake out. As with any new program it will be a work in progress for some time, and there will be adjustments along the way as unintended consequences turn up and are corrected.
  4. by   TheCommuter
    Quote from roreyn02
    Right now nursing and CNA work is one place where you are always able to find a job.
    In many parts of the country masses of nurses and CNAs have been unemployed since the financial meltdown of 2008. Contrary to popular notions, nursing is not recession-proof.

    Moreover, the Patient Protection and Affordable Care Act (PPACA) does not kick in until 2014. Many big businesses are merely using it as a convenient excuse to cut back.
  5. by   azcna
    Why would big businesses want an "excuse to cut back", TheCommuter?
  6. by   azcna
    All facilities are going to have to make changes, especially if there is legislation that forces business to purchase something, or forces them to do something without being paid (such as mandatory emergency tx regardless of pay). Some of this can be written off as charity, but that only goes so far. Hospitals want to stay in business, so if their costs increase and/or their revenue decreases, different cuts will need to be made. A hospital I was recently at said that in their last quarter they lost 50M corporation wide due to non-paying patients.

    Unfortunately this might mean that patio to staff ratios will increase, and time spent per patient will absolutely be cut.
  7. by   neurorn6
    It all comes down to money. Businesses can easily start to hire part time employees only and therefore not have to provide any form of insurance (this includes nursing homes and hospitals). I have been around long enough to know that nursing is not recession proof and that we are expendible in the eyes of our corporation. I would not be surprised if there is a return to the charity hospitals that at one time was dominate in this country.
  8. by   OnceMorewithFeeling
    I agree with Orca.

    This is a big, complicated change. It will take some time before it is all sorted out. Both people and businesses right now are confused and frightened by the change and are reacting and posturing. There may be some difficult times ahead as we all adjust.

    The BEST summation I have read of the ACA is in the following link. It is a clear, thorough, unbiased, and succinct (relatively speaking, it is a big bill) explanation of the ACA:

    CaspianX2 comments on ELI5: What exactly is Obamacare and what did it change?

    Read it, so that you can be more informed about what the bill does and does not do.

    For full disclosure, I support the ACA. I only wish it had included a Public Option as well. As it is, I think it is the most reasonable way to ensure health insurance coverage for the maximum number of citizens within our current for-profit health insurance system.

    A few weeks ago we had a young man (40s) admitted s/p CABG. He'd had stents a few years ago (bad genes!), but could no longer afford his meds. He is a laborer, and supports a large extended family.

    We, as a community, paid for that open-heart surgery. We could have paid for Plavix instead. I know a good deal when i see one.
  9. by   caringinpractice
    Why are the care takers RN LPN CNA SECY and anxillary of the hospital having to take hourly cuts and being sent home early without pay. We break our back for our patients and the bonuses that are paid to the CEO's of "non profit" hospitals are outrageous. One article I ready and these can be found via a google search revealed that one such hospital paid it's CEO $4.2 million in 2011 to celebrate a profitable year and meeting all of its systemwide goals. How is this fair if it is a non profit hospital????? Hey government take note and change the laws SHAME ON YOU for allowing this to happen. What do you all think??
  10. by   USNurse1
    This is where the ANA and it's PAC need to focus their efforts. I strongly feel all nurses should be writing the ANA and their State representative to bring issue with nursing salaries. The dollars floating around healthcare are going in the wrong direction, but Nurses haven't made enough of a stink to create change.
  11. by   Overland1
    Because they are businesses (which are inherently evil because, in order to remain solvent, must make a profit) and because they can . Until we enact federal laws that prohibit such actions, this reprehensible practice will continue to eviscerate our society.

    We need a (federal) Department of Job Security to ensure that jobs everywhere remain intact. If for nothing else, this must be done for the children.
  12. by   HouTx
    PP's are right on target! Uncompensated care (non-paying patients) is an enormous problem for my (large, faith based healthcare system) employer. If you add on the planned cuts in reimbursement as well as the Federally mandated implementation of electronic health records..... YIKES!!! We're in a world of hurt. Unfortunately, the old world where "charity" hospitals (mostly faith based) managed to provide care to the poor is long gone - charitable contributions are insufficient to maintain them. And - despite popular myth, faith-based organizations are NOT financially supported by their church affiliations. The connection is only for the mission & guiding principles; they have to survive on their own. Ex: A huge number of US Catholic hospitals have gone under in the last 10 years and this has created an even bigger burden on the tax supported (charity) hospitals that remain.

    I know that the ideal outcome to US Health Care Reform - if everything works as it is supposed to - will be a simplified system in which we will need fewer clerical people (due to automation), be much more efficient because of reduction in do-overs and errors (again, logical outcomes for automated systems) - and there will be less uncompensated care because more people will be covered by Medicaid... BUT right now it seems like a house of cards that can come tumbling down with even minor political turf battles by our moronic legislators who are more interested in feathering their own nests than the job that they were elected to do. Heck, look at my own state... our "esteemed" gov decided to turn down Fed funds for women's health because he has a personal grudge against Planned Parenthood so we're walking away from tens of millions of Fed funds. Honestly, I feel like I'm living in the movie "Idiocracy"... great satire, I recommend it.

    We all need to make sure we stay educated about all the issues. I am an ANA/SNA/local NA member - have been for 20+ years. This is our political 'voice'. We need to use it!!!
  13. by   LadyFree28
    This is a refreshing dialogue about the evolution of access to HC and our place in it.

    I had a discussion with my fellow colleagues about healthcare in general, including how our wages are factored in our line of work. One colleague took a course in hospital economics during her nursing studies, one did case management with our home care division (we work at an extended day pedi facility) and I have done Medicare chart reviews (payments were confirmed, denied, or reduced due to DOCUMENTATION-it's ALL about the documentation ) as well as worked in home care with shift work and skilled visits ...We have found that MOST insurances, especially Medicare and Medicaid give a set rate on the pt population, acuity and if the pt's condition has a history of a long-standing or potential
    long-standing condition and the severity (that's where ICD-9 comes in...guess its ICD-10 now). That rate is assigned, with a portion of the rate going to nursing care. The HC companies, if nice enough, can add or negotiate the rate per unit or hospitals, units get a set budget per pt care flow, acuity, education, skill mix needs, etc. In community health, such as home health, you get a set rate due to acuity of the pt...for example, if a pt is on a vent=higher acuity=specialized skills=higher pay...again, the business MAY give the set rate by the government, OR negotiate for a higher salary...At a HH agency that I worked with for about 5 years, they have a range of pay for nurses. They do negotiate raises, etc...most of the ranges are based, according to their theory, that the rates on based on government reimbursements, aka, state and local governments.

    It seems to me there is a MYTH that our wages are NOT counted, in which, they are...government has an algorithm on what is to be used on nursing care...Even insurance companies separate nursing care payments from medication and durable equipment...regardless whether it is state run, federally ran, or private insurance...nursing services are in a class by itself. However, the organization that employs nurses has the due diligence to use the money as they see fit, where the issue lies...they just use the song and dance on either cutting costs and put the burden on us...or continuing to be innovative, boosting nursing education, and finding creative ways to care for undeserved pts-either through research studies, or education projects-they are viable healthcare organizations, keep most of their nurses happy, good benefits, upward wages and growth. This is where the ACA comes in regards to nursing and our "worth". I have been fortunate to know a few people who were on the committee for the was my nursing instructor-my research nursing instructor. She and her colleague put together a report on a correlation on pt economics and nursing outcomes involving nursing economics (skill mix, hours involved in pt care, and how the nursing team produces a more favorable outcome. I do like the bill, and it IS pro Healthcare pro pt and PRO nursing-they want nurses to be higher reimbursed because we do see the pts more...NPs are going to be more included...our "worth" has been noticed...but when the political powers (1-800-MALPRACTICE, board members and investors of Suck ya dry Insurance Co) and the Drs and hospitals that thrive off the money (extra CT scan anyone?) complain about Medicare cuts-the reason is the WASTE...why WASTE when the resources should be going to the patients and the NURSES who care for them??? Yes, they can expand more options, but the best things about our government process is that things can be added, tweaked, etc. There is great information out there, free conferences, even a FREE class about the ACA...I believed it is sponsored by the University of is free online.

    A lot of companies are using the ACA to cut wages, not give out raises, not reimburse for schooling, and continuing education. I work at a non-profit, and I JUST got a wage adjustment, six months after I obtained my licensure. My manager found a way not to give me a 3% raise...go plan is soo outrageously priced...400 dollars a month, including a big deductible...told a lot of my colleagues to get private insurance, which is 50% cheaper, no huge deductible, and can't raise rates anymore (thanks to the ACA). I'm just glad I obtained employment elsewhere, where I will not be "short changed" anymore...I hope that the ACA will benefit us, from wages to insurance for us as well and for the...we can take care if ourselves better while taking care of our pts, as long as we keep getting the facts, and making sure we stay informed and involved.
  14. by   tewdles
    "I have done Medicare chart reviews (payments were confirmed, denied, or reduced due to DOCUMENTATION-it's ALL about the documentation"

    I highlight this because in Home Care documentation is the thing that the agencies seem not to want to pay for...and where the RN documentation is CRITICAL to payment.

    The knee jerk reaction of management will be too cut back on their most expensive "labor" costs (nurses). Nurses have TONS of beautiful evidence to prosecute that plan and are prepared to take a national stand, IMHO.