Obamacare? what are your thoughts

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Hello ladies!

As healthcare professionals, what are your opinions on Obamacare?

Specializes in ER, Trauma ICU, CVICU.

The system is so broken, and I would be only guessing to hypothesize what might happen... its not a miracle. There is a lot not to like about the ACA, I don't even have the time or energy to get into it.

HOWEVER, I do think that besides increased red tape/requirements the ACA is actually really favorable for nurses, especially advanced practice nurses. It has several clauses increasing access to care via CRNAs, NPs, and Nurse Midwives. That is something I really like. I have heard of nurses having hours cut, etc. I'm not sure how that works or why that is happening. I haven't personally seen it besides via my friends in home health care. In my opinion that is one part of our industry that needed to be a little stricter anyway.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Hi, markbsnrn

Our search bar top right corner form or bottom of every page is available to see if a topic has previously been discussed prior to posting a new thread so you can jump into the current discussion. We have several threads on topic:

Obamacare? what are your thoughts has 188 responses

Merged posts with this thread as same topic.

Also see:

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PRN hours decreased because of the ACA

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Nurses laid off - Thanks to Obamacare

Affordable Care Act- How it affects NPs

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Specializes in Family Nurse Practitioner.

So true.....

http://time.com/88535/obamacares-killer-burden-on-nurses/

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Now, I will take care of patients who are new to health care. Some haven’t had care in a long time (or ever). Some may have pre-existing conditions that enabled insurance companies to refuse them coverage. As they enter my care, their needs may be more complicated.

While I hope the ACA will get care to millions of other Americans, I worry that it may make it harder for people to get comprehensive, timely care from trained and compassionate health care practitioners, including nurses like me.

I thought this article had a confused message.

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Specializes in Critical Care.

I sometimes think it's unfortunate nurses don't have a more prominent voice when discussing healthcare issues, it's really unfortunate that when a nurse does get to share their views in such a prominent forum that they can't meet the basic standards of a high school research paper.

She initially points out that the intention is to manage health conditions more in the primary care setting, where it's much cheaper to manage while still in the less acute stages. After that, her sense of logic completely breaks down.

She points out that "Now, I will take care of patients who are new to health care", which would make sense if she worked in primary care or chronic disease management, but she doesn't, she works in non-elective acute care, where there's no reason to believe we'll see an increase in patients due to Obamacare since by law this type of care has been guaranteed for a very long time. She gives this non-existent increase in acute care patients as the basis of her concern that it will overload acute care resources.

She shares the story of a patient admitted for complications of diabetes who didn't utilize primary care services and therefore her first interaction with healthcare was when she was admitted, which is the problem we had before Obamacare that we're hoping to reduce by making insurance, and the primary care that goes with it more accessible.

This was a highlight of various examples of inept logic: "The problem with that diagnosis? My patients are not healthier". She works inpatient acute care, so no, by definition your patients are not healthier, if they were healthier they wouldn't be admitted and become your patient, that's the point. It's sort of like if an ICU nurse said "for some reason all of my patients are really sick".

She ends with an astonishingly ignorant statement of the difference between acute hospital care and primary care. She laments that only by being in a hospital with an acute condition related to her previously unmanaged diabetes has her patient been able to obtain diabetic teaching, which according to her wouldn't be available in the primary care setting, which I'm sure would come as an (offensive) surprise to diabetes clinics, diabetes educators, and endocrinologists everywhere.

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You won't find a bigger critic of Obamacare than myself. But as a nurse in the acute care hospital setting, I don't see how it's going to make my patients sicker then they are already by the time I see them.

And I see that the nurse who wrote it at a Kaiser hospital. Maybe I'm not totally understanding how it works, but wouldn't her patients before and after Obamacare have insurance (Kaiser)?

That article is nonsensical. It's embarrassing that is the best thing from a nurse that a news outlet like Time could get.

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The verdict is still out on Obamacare but the writing is on the wall. If you look at how the magnet status and requirement for BSN is becoming more prevalent, the nurses are most likely to get squeezed due to the consolidation in the numbers of healthcare facilities nationwide. Business is business even in healthcare which means people will pay for these top hospitals and the non profits will service Medicaid. The have's will go to these Magnet hospitals with the most advanced tools and best doctors and will be reimbursed accordingly. ( remember if you can pay for insurance ( platinum) you're more likely to be healthier than those who can't work; hence the lower level bronze level patients will be relegated to urgi-centers and non profit hospitals). The capitalist view of medicine is how this is all headed.

For RN jobs, the amount of hospitals available directly reduces the number of available positions for nurses -with a few exceptions where hospitals with funding will expand some of their available departments in order to attract the right kind of doctors and then the nurses to support the influx of patients in those departments expanded. Even with these exception for additional head count, they are far outnumbered by the closures of uncompetitive, therefore underfunded hospitals. These hospitals will ultimately be closed or reduced to more competitive urgi-centers and Medicaid patients. The lesser funded hospitals will increase ratios to stay afloat. The better funded will be very picky when selecting RNs because they are going to be looking how they can attract the more wealthy individual patients with better reimbursement.

OBamacare will accent the haves and have nots. People lives will become, as it is somewhat today, where the better hospitals are the better patient outcomes will be. Capitalism vs healthcare. Obamacare vs good universal healthcare.

the insurance companies will be owning these magnet corporations before long...then RNs will lose the leverage with unions they are slowly losing today. Pay will most likely go down as well as a result because there is no pressure or shortage of nurses. It's a matter of supply and demand. It's simple to some extent.

guyNurse

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Nope, sorry. The debate is over. Obamacare is the law of the land, Nancy Polcy has called it beautiful, and if you don't agree that it is the best thing ever you are racist, stupid, ignorant, uncaring, a horrible nurse, and/or a member of the tea party.

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Specializes in Emergency.
The verdict is still out on Obamacare but the writing is on the wall. If you look at how the magnet status and requirement for BSN is becoming more prevalent, the nurses are most likely to get squeezed due to the consolidation in the numbers of healthcare facilities nationwide. Business is business even in healthcare which means people will pay for these top hospitals and the non profits will service Medicaid. The have's will go to these Magnet hospitals with the most advanced tools and best doctors and will be reimbursed accordingly. ( remember if you can pay for insurance ( platinum) you're more likely to be healthier than those who can't work; hence the lower level bronze level patients will be relegated to urgi-centers and non profit hospitals). The capitalist view of medicine is how this is all headed.

For RN jobs, the amount of hospitals available directly reduces the number of available positions for nurses -with a few exceptions where hospitals with funding will expand some of their available departments in order to attract the right kind of doctors and then the nurses to support the influx of patients in those departments expanded. Even with these exception for additional head count, they are far outnumbered by the closures of uncompetitive, therefore underfunded hospitals. These hospitals will ultimately be closed or reduced to more competitive urgi-centers and Medicaid patients. The lesser funded hospitals will increase ratios to stay afloat. The better funded will be very picky when selecting RNs because they are going to be looking how they can attract the more wealthy individual patients with better reimbursement.

OBamacare will accent the haves and have nots. People lives will become, as it is somewhat today, where the better hospitals are the better patient outcomes will be. Capitalism vs healthcare. Obamacare vs good universal healthcare.

the insurance companies will be owning these magnet corporations before long...then RNs will lose the leverage with unions they are slowly losing today. Pay will most likely go down as well as a result because there is no pressure or shortage of nurses. It's a matter of supply and demand. It's simple to some extent.

guyNurse

It is already/has been/has not really changed... like what you are describing...I believe and have expounded numerous times...The ACA is a band aide on a gaping wound...single payer works in all the-as Bill Maher so aptly put it...in all the "Big boy/grown up countries..." perhaps someday we here in the good ol' USA will get out of our own way!

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Specializes in Education, research, neuro.
It is already/has been/has not really changed... like what you are describing...I believe and have expounded numerous times...The ACA is a band aide on a gaping wound...single payer works in all the-as Bill Maher so aptly put it...in all the "Big boy/grown up countries..." perhaps someday we here in the good ol' USA will get out of our own way!

No... single payer doesn't work flawlessly. Consequently, some of the "big boy" nations are allowing people with resources to operate in a better, parallel system much like we can still remember. So single payer appears to become a dual system, one for the haves and one for the little people. There's a lot about progressives I don't understand but I know the current buzz words are "equity" and "equality" and I don't believe the rich having excellent care and the less rich getting to wait 18 months for a knee replacement is what they are after.

If I'm wrong, I'm sure you'll tell me. Broad introductory comments are very easy to twist.

Here is what I find indefensible. WE DON'T HAVE THE ACA. We have whatever the h*ll HHS wants the law to be this week. It had an incredibly incompetent roll out, we have had arbitrary delays on uncomfortable provisions that could swing elections. As we speak, the computer program is being reworked to something else for the November open enrollment deadline.

There are over 2 million applicants whose data don't fit (remember, PAPER applications are still being processed) and it cannot be determined whether many have paid their first premium. Which is just A-OK with the politicians whose careers are riding on this because if the real data were available, it would look lame. It's data no one can get. Just trust us. 8 million people are enrolled. The cost curve is being bent downward and if you like your doctor you can keep your doctor.

Most egregiously, it is now being admitted that almost no one is going to pay the penalty for not signing up for insurance because (again, totally apart from the law itself) if you've had a "life-changing event" in the last year, you're excused.

WITHOUT THE MANDATE YOU DO NOT HAVE THE ACA. The care for the uninsured was supposed to be born by the young and healthy who would perforce buy expensive policies OR, having failed to do so would face a penalty to be assessed by the IRS. NOW we are told that anyone can avoid the penalty. You just sign an attestation to the fact that your life has changed... and you skate. THIS IS NOT IN THE ACA.

The interest group with the most pull in DC are labor unions whose members will pay a 45% tax on their "Cadillac plans" and the betting is on as to how the law will be twisted again to keep that constituency happy.

We don't have a health care law. We have a slow-rolling train wreck.

And it is at this point that those who celebrated the ACA (per the quote noted above)... tell us "well, we wanted a single payer system... we could only get a half measure because the T-party, foul Republicans, Chamber of Commerce, rich 1 percenters wouldn't let us have what we really wanted. So, you see... it's their fault.

No one on the right supported this. It is your baby. Live it. Love it.

I am also told that the "party of no" has nothing positive to offer. The President laments that all he hears is criticism and if just one person would come to him with suggestions... (meanwhile if you like your doctor you can keep your doctor and Oh baby, of COURSE I'll love you in the morning). While I don't think it's my job to dig up information readily available to those who have complete field-cut/neglect on their right... I offer just one of many that are being proposed and have been proposed by evil conservatives. There have been all along. This is only ONE offering available from the Manhattan Institute.

http://www.economics21.org/commentary/covering-pre-existing-conditions-market-driven-health-system

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No... single payer doesn't work flawlessly. Consequently, some of the "big boy" nations are allowing people with resources to operate in a better, parallel system much like we can still remember. So single payer appears to become a dual system, one for the haves and one for the little people.

Here is what I find indefensible. WE DON'T HAVE THE ACA. We have whatever the h*ll HHS wants the law to be this week. It had an incredibly incompetent roll out, we have had arbitrary delays on uncomfortable provisions that could swing elections. As we speak, the computer program is being reworked to something else for the November open enrollment deadline.

We don't have a health care law. We have a slow-rolling train wreck.

And it is at this point that those who celebrated the ACA tell us... well, we wanted a single payer system... we could only get a half measure because the T-party, foul Republicans, Chamber of Commerce, rich 1 percenters wouldn't let us have what we really wanted. So, you see... it's their fault.

You are so right. That train has jumped the tracks, and the fine folks in Washington, D.C. who gave us this train wreck are either 1) insisting that the train is still rolling along just fine, or 2) blaming everyone but themselves for the wreck and punishing anyone who points to it and says "Holy ****! Look at that!".

The ACA was sold as "Whoopeeee!...health care for everybody!", but what it really is, is socialized/subsidized health insurance for everybody (that is, unless you just want to pay the penalty, or you're Amish, or something else to be determined by some bureaucrat). The ultimate goal of those who wrote it (but didn't read it before they passed it) is to get to a single-payer system, to be run by those same folks who gave us the VA system, TSA airport screeners and Cash For Clunkers. You may have a health insurance policy under the ACA, but good luck finding a doc or a hospital that will accept you as a patient. Oh, and by the way, your premiums, co-pays and deductibles all just shot up by 200%. Oh, and that baby you were planning to deliver at Local General just down the road? He is now going to have to come into the world at Faraway General, down in Banjo County, just a short, 150 mile scenic drive from your home. But don't worry, your new OB/GYN graduated in the top 85% of his med school class on that lovely sun-drenched island.

If you want a glimpse of how well "single payer" works, just take a look at your local VA Medical Center. You'll likely get pretty decent care once you're in there, but before that happens your request for an appointment may outlive you, buried in a stack of stuff in somebody's desk drawer. They were just "too busy" to deal with it before going on a smoke break/lunch/vacation/retirement. And besides, the union says they're entitled to that vacation time along with the bonuses they receive for delivering such high quality service.

The bottom line to this is that we're creating a two-tiered system; one for the "haves" who can pay out of pocket for top quality health care, and one for the rest of the unwashed masses who will have to live (or not live) with Health Care for Clunkers. But, not to worry. It will only cost about the same amount as the GDP of an EU country. And, of course, we'll all be too busy congratulating ourselves on our "compassion" to notice.

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Specializes in Education, research, neuro.

I will correct you before our progressive friends. The VA is not a single payer system. It is overtly socialized medicine where the government owns the facilities and the people that work in them.

But your point is taken. VA, Post Office (an interesting "hybrid" that was supposed to work with government input) TSA, IRS, ATF, NSA, BLM... They're all doing great work for the American people. I am so glad the Feds are taking over to make sure I can get health care. They know what I need and how much I can pay much better than I do. Holy Smoke... how did I live as long as I have without their direct intervention?

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