Obama Care and how will it affect nursing salary and pay

ArtClassRN, ADN, RN · Oct 9, 2013

I'm curious!! How is this Obama care affect our salary and pay. Given that the lower cost of health care will be available to many more people, are we expecting a pay cut as nurses?

Given that there will be savings from more people having access to primary care and current revenue streams remain intact, we should not expect a pay cut as nurses. Now, you may have an employer try to claim this, in which case you would want a good union in place for collective representation.

vcoronel127 · Oct 9, 2013

Given that there will be savings from more people having access to primary care and current revenue streams remain intact we should not expect a pay cut as nurses. Now, you may have an employer try to claim this, in which case you would want a good union in place for collective representation.[/quote']
Thank you for that input. With all this ObamaCare and government shutting down, I was getting conceded about possible pay cutbacks. This should be good news for all is nurses

ArtClassRN, ADN, RN · Oct 9, 2013

Thank you for that input. With all this ObamaCare and government shutting down, I was getting conceded about possible pay cutbacks. This should be good news for all is nurses

The government shutdown is nothing more than a minority of yahoos in the House playing chicken wth the Continuing Resolution. They lost elections and the elected representatives they lost to passed laws that held up under Supreme Court review. That's it. That's how the system works.

Now, a minority of "Tea Party" representatives want to supersede the entire democratic and Constitutional process, have their special little temper tantrum, and claim others "won't negotiate" with them. For crimony.

I hope they lose even more elections in the future because of their shenanigans.

That being said, we will all have to wait and see what the actual effects of the Affordable Care Act are on the country - just like we have had to assess every other law passed by Congress.

DoGoodThenGo · Oct 9, 2013

Given that there will be savings from more people having access to primary care and current revenue streams remain intact, we should not expect a pay cut as nurses. Now, you may have an employer try to claim this, in which case you would want a good union in place for collective representation.

But revenue streams are not remaining "intact". Cuts have been made to Medicare reimbursements that have already affected facilities, and IIRC more are to come. Then there is the fact many insurance companies are pushing for lower rates as well. Both of these are at the wave of mergers and take overs as hospital systems seek to gain stronger positions by growing larger.

Also it is not the *cost* of healthcare that is lower under "Obamacare" through there are provisions and so forth to attempt to bring the thing down, but the price of health insurance that is going to decrease (for many) at least in theory. The two are not always mutually related.

Main idea behind this scheme is that persons who previously either were under or uninsured would have a decent healthcare scheme. This in turn would reduce dollars hospitals lost to unpaid/charity care. It should also increase use of some services as those previously without coverage now engage in the healthcare system. Will all this cause hospitals, physicians etc... to lower their rates and or bring down cost? We shall have to wait and see.

Finally going back to wages, many facilities have been very active in finding ways to reduce their "overhead" including nursing service costs. Inpatient beds are being eliminated, units, floors and even entire hospitals closed, you get the picture. Then there are issues with staffing ratios and or use of UAPs.

Esme12, ASN, BSN, RN · Oct 9, 2013

cuts are already occurring.....layoffs are happening...nursing aren't receiving raises in many facilities....benefits are being cut across the board.

https://allnurses.com/nursing-news/another-one-bites-856276.html#post7557886

Vanderbilt Hospital to let 1,000 go...

Lay offs loom at Cleveland Clinic...

Big pay cut at Orlando Health, please help your fellow Nurses ...

Home Health Columnist / Guide · Oct 9, 2013

I see a golden age for RN's ahead in varying roles-some inside but mostly outside hospital 4 walls.

AARP: 11 Myths About Health Care Reform

"The amount of misinformation about the Affordable Care Act [ACA]- including outright lies-is astonishing," says Shana Alex Lavarreda, Ph.D., director of health insurance studies at the UCLA Center for Health Policy Research. "The point of the law is to make the health system better for each person, for less cost to society overall."
MYTH 1: The new law cuts Medicare drastically, so I won't be able to get quality health care.
The Affordable Care Act (ACA) in fact prohibits cuts to guaranteed Medicare benefits. There are provisions in the law to help curb the soaring costs of Medicare, but savings will come from reining in unreasonable payments to providers, taxing high-premium plans (beginning in the year 2018), cracking down on fraud and waste, and encouraging patient-centered, coordinated care, says Sara R. Collins, Ph.D., vice president of the Commonwealth Fund, a private research foundation focused on health care.
The ACA also covers preventive care designed to avert chronic conditions like heart disease and diabetes, which currently cost billions. Medicare beneficiaries get an annual wellness exam as well as numerous screenings and vaccines free of charge. The new system also improves coordination of care between doctors, nurses and other providers to prevent harmful and costly hospital readmissions.
Finally, the law closes the infamous Medicare Part D prescription drug "doughnut hole," in which Medicare beneficiaries paid full price for prescription drugs after exceeding a certain dollar limit each year. Now enrollees who reach the doughnut hole get large discounts, and by 2020, the hole will close.
MYTH 2: I've heard that Medicare Advantage plans will be cut or taken away.
The ACA does not eliminate Medicare Advantage plans, which are privately administered plans that provide benefits to about a quarter of Americans with Medicare. These plans were created to bring market efficiencies to Medicare, but they actually cost taxpayers 14 percent more per enrollee than the traditional Medicare program does. The ACA aims to bring costs back into line.
"The plans are still required to provide at least the same benefits as those available through traditional Medicare plans," says Stuart Guterman, vice president of the Commonwealth Fund. "And for the first time, the law ensures that plans that perform better will be paid better, so the care they provide should improve."
MYTH 5: The new law "raids Medicare of $716 billion."
It's simply not true. The Congressional Budget Office (CBO), Congress' independent and nonpartisan budget scorekeeper, recently estimated that the changes to Medicare in the ACA will reduce spending by a total of $716 billion between 2013 and 2022.
"That's where the number comes from," says Guterman. The largest portion of these savings would come from changes to provider payments and correcting overpayments to insurance companies that offer private Medicare plans. "And that projected savings will be used to close the prescription drug 'doughnut hole'; to pay for free, preventive care for consumers; and to increase coverage for the uninsured," Lavarreda say.....
..MYTH 7: The new law will drive up premiums astronomically.
That's an unlikely scenario. "A significant number of the uninsured people who will be brought into the system with the ACA are the 'young invincibles,' " says Brownlee, describing the 18-to-29 age group. "Their relative good health helps to subsidize care for less healthy people."
The law also strengthens states' power to question unreasonable rate increases, whether because of age, preexisting conditions or any other reason. And the law's "medical loss ratio requirement" dictates that 80 to 85 percent of premiums be spent on medical costs. As of Aug. 1, approximately 12.8 million Americans received an estimated $1.1 billion in rebates from insurance companies in cases where overhead expenses exceeded 15 to 20 percent of premiums charged in 2011.

What many healthcare systems are seeing is a change in payer mix, significant decrease in hospitalizations in some areas as care shifted to outpatient surgicenters, drop in Medicare reimbursement for overnight/ 2 day stay for Medicare patients now considered outpatient "observation", increased claim denials for unbundling of procedures, and requirement that health insurance be provided to employees working more than 24hrs/week.

Some healthcare systems are in an all tizzy with extreme belt tightening to what COULD happen and realizing they've overbuilt/beautified hospitals. Other health systems have been belt tightening + planning for past 3-4year for changes in business environment.

In my area, significant increase in focus in CARE COORDINATION activities as means to prevent rehospitalizations and helping patients get coorrdinated care they need focusing on oncology, planned orthopedic procedures especially joint replacements, and cardiac services..... isn't it ironic that the ACA has $$$ for Care Coordination in it... surprise, surprise. Old days of "discharge planner RN's" writing up transfer summary to SNF/homecare, and faxing DME RX over without any followup-have bitten the dust.

Highly touted "Nurse Navigators" abound in area Hospital ads. My employer's Home Care Liaisons are now welcomed with open arms at most hospital, rehab, SNF, assisted living and physician offices: along with writing up request for homecare, they order medical equipment supplies, arrange for home lab draws and with hospital based liaisons setting up Telehealth equipment for next day home instillation.

Allnurses Entrepreneurs in Nursing forum showcasing many ways RN's expanding into outside hospital roles.

DoGoodThenGo · Oct 9, 2013

Great post NRSKarenRN!

It goes to something myself and others have been saying for awhile now, despite everyone and their mother seeking hospital positions, the bulk of growth in future choices are more likely than not going to be out in the community.

The United States is slowly moving towards what is considered "normal" in the rest of the world healthcare/hospital wise. In many areas of this country there is a vast over supply of hospital beds brought about often by having too many facilities in a geographical area. We are also slowly but surely moving to keeping persons out of hospitals and reducing the need for patients to return shortly after discharge. Community/district nursing plays a larger role in many European countries healthcare systems and one suspects that is how the United States is going.

Just using Manhattan, NYC as an example; from East 57th Street to East 105th street there are NYP, Memorial Sloane Kettering, Hospital for Special Surgery, Lenox Hill Hospital, Metropolitan Hospital, Ear, Eye Nose Infirmary and Mount Sinai Hospital.

If you strip out MSK ( a highly profitable and rapidly expanding cancer destination/specialty hospital), you have New York Presbyterian on East 68th and Lenox Hill within just twenty city blocks of each other. Of the two NYP is the behemoth physically and expanding rapidly up and down First Avenue and indeed all over the UES. Lenox Hill is a small community hospital that despite serving historically the wealthy population of the UES almost shut down a few years ago. It took the big money bags of North Shore-LIJ to purchase (in cash) and keep the place open.

Any sane and rationale hospital planning most elsewhere in the world would balk at having two major hospitals located so close to each other. Same as when Saint Vincent's closed many said the place was not needed because *three* large hospitals (Bellevue, Beth Israel, and NYU) are just across town on the East Side. They are also all located within several city blocks of each other as well. Even with Saint Vinny's gone Beekman Downtown left as the only remaining hospital on the West Side below 14th Street couldn't make a go of things. It was purchased/fully absorbed into the NYP-Columbia healthcare system.

Years ago when this hospital system or group of physicians wanted to poach population from a community, they opened a full service hospital or medical center, that is no longer happening in many areas. Again here in NYC units are closing, beds reduced and hospitals shutting down. What you have is an extensive and growing network of urgent/ambulatory care and hospital affliated/owned physician practice offices.

While Long Island College and several other Brooklyn hospitals are struggling to stay open, NYP and other "Manhattan" healthcare systems are busy opening and expanding various ambulatory and out patient care offices. Hospital networks realize you no longer need to build a full service place to get patients. Just service them via these various out patient services and or if need be funnel them to the main system facilities located elsewhere.

As it relates to nursing these various out patient services are great for reducing the need for nurses. They don't require full 24/7 staffing with many not open past 7PM or on Sundays.

DoGoodThenGo · Oct 10, 2013

I'm curious!! How is this Obama care affect our salary and pay. Given that the lower cost of health care will be available to many more people, are we expecting a pay cut as nurses?

May or may not have anything to do with ACA or whatever, but this is how one of the largest NYC hospital networks (NYP) is offering for new grads.

https://allnurses.com/new-york-nursing/nyp-new-grad-828011-page24.html

Scroll down to the last few pages and you'll read posts from those interested and or applied for these new grad spots.

Basically NYP is not only hiring these nurses via an agency but is offering (vastly) lower wages than what is normal for new grads in that system.

One has a sneaking suspicion that by using an agency the hospital gets round any *ahem* problems with unions.

LadyFree28, BSN, LPN, RN · Oct 10, 2013

Great post NRSKaren!!!

Time to release the myth that a good nurse MUST be a hospitals nurse. :yes:

BlueDevil,DNP, DNP, RN · Oct 12, 2013

I agree that nursing is evolving, and that there will not be near as much need for nurses in hospitals in the future. I think parish and community nursing is looking at a huge uptick.