Obamacare? what are your thoughts

BlueDevil, DNP · Jun 9, 2014

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

Just about everything in this post is incorrect from beginning to end. The writer clearly has no understanding of insurance contract negotiation, capitated payment systems, medicare, medicaid billing rules, or the difference between profit and not for profit institutions or their respective accounting practices. The rest of the post has to be acknowledged to have been written by an individual whom has no idea what he is talking about.

SycamoreGuy · Jun 11, 2014

Single payer is like medicaid/Medicare and Tricare. They are far from perfect, but as a Tricare recipient I love it. I have great doctors and a large pool to select from if I don't like my doctor or they move. The people posting that the VA is socialized medicine are so true. My husband is active duty and receives socialized medicine. The waits are long and good treatment is hard to come by. It will be a great day in 2 years when he retires. He will then join me in a single payer system. There is such a world of difference in single payer and socialized medicine. Single payer you have choices and socialized medicine you don't. You get what you get when they say you can get it.

As another tricare recipient I have to disagree with your assessment of socialized medicine. Sure if you live in a large military area you can find an in network provider. Try finding one in an area with a smaller military population. It took two months for me to find an in network provider that was accepting patients when I moved. Then if I needed to see her I had to schedule appointments two months out. That ruled out any sick visits, my only options for sick visits (the majority of my visits beside annual physicals) are urgent care clinics (a $90+ copay) or the ER. I'm really not much better off than just paying the full cost of urgent care visits, oh but wait, if I don't carry insurance I get a tax penalty.

damrcngrl95 · Jun 11, 2014

As another tricare recipient I have to disagree with your assessment of socialized medicine. Sure if you live in a large military area you can find an in network provider. Try finding one in an area with a smaller military population. It took two months for me to find an in network provider that was accepting patients when I moved. Then if I needed to see her I had to schedule appointments two months out. That ruled out any sick visits, my only options for sick visits (the majority of my visits beside annual physicals) are urgent care clinics (a $90+ copay) or the ER. I'm really not much better off than just paying the full cost of urgent care visits, oh but wait, if I don't carry insurance I get a tax penalty.

I'm sorry you have had such a hard time finding a provider. I have lived in some small nonmilitary towns and never had a problem getting a provider right away. I did have a hard time getting specialty care such as a pulmonolgist, but it wouldn't have mattered what insurance I had because the town didn't have anything like that. Tricare is not socialized medicine, but the VA and the doctors for my active duty husband is socialized medicine. With that, I'm not very impressed.

Look up Holdenville, OK or Alice, Tx. Sure I could have gone to Oklahoma City (Tinker AFB) or Corpus Christi Naval Base, but I never had to leave my little town and my doctors as well as my children's doctors never had a problem with Tricare.

MunoRN, RN · Jun 11, 2014

Our overall health provider system isn't single payer or socialized medicine, it's a mix of various insurance providers which is what gives us different provider networks in the first place. If you don't like that it can be hard to find a doctor who takes your particular insurance it's not because we have a single insurance source (single payer) it's because we don't. In a single payer system, if there is a doctor nearby who takes insurance, then there's a doctor nearby who takes your insurance.

BlueDevil, DNP · Jun 12, 2014

Primary care access here is complicated, but not because of the ACA. The number one driver complicating access in our practice is Medicare Advantage. We hate it, and practically have come to hate those patients. We do everything we can to avoid seeing those patients and to avoid referring them to specialty. Their care managers do everything in their almost limitless power to make sure their don't get any other interventions either. MedAvd is the single biggest ripoff in health care (to the pt, the provider and the taxpayers alike) and it should be abolished, yesterday.

We have most of the specialties covered. There are a zillion pulmonologists, orthopods, endos, cardiologists, and heme-oncologists. Plenty of surgeons of all varieties, plenty of dermatologists, radiologists, gastros. But Dog help you if you need a neurologist (although we have a plethora of neurosurgeons, go figure) or rheumatologist. And psych- just fuggedaboutit The state's position seems to be "just go ahead and kill yourself already." No beds, no therapists, no shrinks. Sad. The only way you are getting any significant behavioral health care outside of primary care is if you kill and eat several of your neighbors.

My panel was full before the ACA, but people die/move, etc. I do see new people from time to time, and we have gotten a lot of new ACA pts. Most of them aren't train wrecks, just 30-40 year olds who want preventive health care or have had a nagging subacute issue they are happy to have addressed. There have been a few catastrophes and at least one tragedy I have heard about for want of insurance. For the most part, things have gone smoothly and I am not personally aware of any undue burden on the system.

TraumaQueen57 · Jun 12, 2014

Train wreck.

MunoRN, RN · Jun 13, 2014

Train wreck.

A thorough and well reasoned argument.

toomuchbaloney · Jun 13, 2014

A thorough and well reasoned argument.

Aren't you accustomed to thorough and well reasoned arguments on this topic by now?

allnurses Guide · Jun 13, 2014

Nearly all providers take Medicare. Many primary providers and specialists will take Medicare only if the person says they can't afford a supplement. My doctor charges $5.00 for follow up visits after the yearly preventative visit for those who have no supplemental insurance.

I'm glad I can afford a supplement because hospitals and labs won't take Medicare only.

A retired nurse choose a Medicare Advantage plan because it saves her the cost of a supplement and offers a free gym membership. (I pay $14.00 a month for my gym and probably save some by showering there.)

I believe a Medicare Advantage plan killed my Daddy. His PSA was rising every year. I told him he should see a urologist. His "gatekeeper" primary physician wouldn't refer him.

My Daddy was a smart man, but wouldn't pay for the specialist because he trusted his doctor. The 4th year it continued to rise the doctor tried to do a biopsy.

After six years my Daddy thought he had hurt his shoulder playing tennis. Bone metastases from prostate cancer were seen on X-ray.

He died four months later. I cared for him in hospice with the help of wonderful nurses and others.

If he had kept his Medicare he could have referred himself to a urologist.

BlueDevil, DNP · Jun 14, 2014

I'm sorry Herring. MA is, IMO, one of the worst things that has ever happened to American health care. All the complaining about the ACA is nonsense. It is simply health insurance. In some cases it isn't great health insurance, but for people that had none, it is an improvement. MA, on the other hand, is actively stealing from taxpayers while the beneficiaries are conspiring to withhold care/treatment from the subscribers at any cost. I have seen several patients suffer catastrophic outcomes b/c of MA practices. It kills me, b/c these pts, to a one, believe they have premium insurance and can be quite smug about it (because they pay more for it), when in fact, they have some of the worst plans on the market. It is very sad and frustrating. They want the best, they can often afford it, so they get the most expensive without realizing they are being conned.

Those of us that are contracted with these plans are penalized when we refer to speciality care, when we order labs, imaging, PT, etc. It is, literally, money out of the providers pocket at the end of the fiscal year. We are given multiple disincentives to provide needed care for the patient, and even if we decide to ignore those and do it anyway, they block us and refuse to authorize it time and time again. And that is so grossly (in every sense of the word) unethical, I can't even comprehend how that ever got passed.

I'm sorry for your loss.

allnurses Guide · Jun 14, 2014

My friend's Medicare Advantage plan costs her nothing. It has no premium or copay.

She praises it all the time because she likes the "free" gym membership.

At 68 she is basically healthy. I'm afraid if she gets seriously ill or injured she may regret giving up traditional Medicare. There are only two hospitals in her plan. She knows what happened to my Dad, but says she has another company.

I would never advise anyone to even consider Medicare Advantage.

http://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-advantage-plans.html

BlueDevil, DNP · Jun 14, 2014

I am only familiar with the plan with which my group contracted. It is fairly pricey and it's participants are generally "well heeled" and refuse to believe they have been duped.

They get "Silver Sneakers" (a $30 a month value!) but only the very cheapest drugs and in limited quantities-no exceptions. No home health, no PT, no OT, no ST, no skilled nursing, no chest tube drainage bag changes, no ostomy supplies, no follow up on abnormal lab values, only minimal lab screening in the first place, no mammograms after age 75, no colonoscopy after age 75, no counseling, no ercp, no mrcp, no cta, no mri, no specialty visits without prior auth, and then only the in-network provider. no 2nd opinions.