Obamacare? what are your thoughts

Nurses Activism

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Hello ladies!

As healthcare professionals, what are your opinions on Obamacare?

He had nothing to do with the specifics of the plan.

You are very naive if you honestly think that. On another note, should you sign something when you don't know the implications of it?

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No, It really doesn't boil down to that at all. It means that now people can be insured even if they have pre-existing conditions where as before insurance companies only took on healthy people where they could make money collecting monthly payments off people who never needed care. What is the point of having a car and a house if you are dead?

While there may be some positive thing in the legislation taken as a whole it's a mess. What's worse is democrats weren't even willing to fix it until they realized that they very well might lose elections over the mess they created.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
While there may be some positive thing in the legislation taken as a whole it's a mess. What's worse is democrats weren't even willing to fix it until they realized that they very well might lose elections over the mess they created.

Perhaps you could provide us a link to some Republican fixes that Democrats refused?

Just recently Republicans did pass a small fix (Democrats were happy to oblige) and they did it without a roll call vote to insure that none of them had their Republican names next to a yes vote associated with the ACA.

As a whole it is not a mess...you just prefer to think it is. All comments to that effect are based upon anecdotal evidence that doesn't stand up to scrutiny.

What is a mess are scores people who do not meet the criteria for subsidies and whose state did not expand medicaid leaving them high and dry so that their Republican political leadership could make a partisan political point. One of those victims just died in Florida because of her lack of access to affordable insurance coverage.

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Can you show that her death was a direct result of her lack of coverage? Was she denied treatment? The answer may be yes, I'm not familiar with this case.

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You are very naive if you honestly think that.

Please show me some documentation of my naivete'. The entire reason the bill is a "mess," which I heartily agree it is, is because the Democrats in Congress designed it to include the GOP supposed wishlist, rather than a program that Democrats would design themselves, in an attempt, eventually futile, to get the GOP members of Congress to help pass it. Chuck Grassley played footsie with Max Baucus all summer in the hearings, while Baucus caved on every GOP request for additions/changes to the proposed bill, and then even Grassley voted against it when it finally came to a vote, after almost everything he asked for had been included in the bill.

If Democrats had written the bill to their own liking, it would be significantly different from the minor tweaking around the edges that we ended up getting.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Can you show that her death was a direct result of her lack of coverage? Was she denied treatment? The answer may be yes, I'm not familiar with this case.

The perils of Florida's refusal to expand Medicaid - News & Features - Orlando Weekly

Dill's death was not unpredictable, nor was it unpreventable. She had a documented heart condition for which she took medication. But she also happened to be one of the people who fall within the gap created by the 2012 U.S. Supreme Court ruling that allowed states to opt out of Medicaid expansion, which was a key part of the Affordable Care Act's intention to make health care available to everyone. In the ensuing two years, 23 states have refused to expand Medicaid, including Florida, which rejected $51 billion from the federal government over the period of a decade to overhaul its Medicaid program to include people like Dill and Woolrich - people who work, but do not make enough money to qualify for the Affordable Care Act's subsidies. They, like many, are victims of a political war - one that puts the lives and health of up to 17,000 U.S. residents and 2,000 Floridians annually in jeopardy, all in the name of rebelling against President Barack Obama's health care plan.

THAT political grandstanding is the hot mess you keep referring to.

THAT is the type of partisan posturing that is adversely affecting Americans.

Perhaps Fox News didn't cover this story? Hannity didn't convene a panel to discuss the evils of this situation? O'Reilly didn't include the story in his opening remarks? The Koch brothers haven't purchased any TV ads to educate America about this?

Just another dead poor person, nothing to see here, move along...

Expanding Medicaid to low-income adults leads to improved health, fewer deaths | HSPH News | Harvard School of Public Health

"Sometimes the political rhetoric is at odds with the evidence, such as claims that Medicaid is a 'broken program' or worse than no insurance at all; our findings suggest precisely the opposite," said Epstein.

Without Medicaid expansion, no insurance for 500,000 in N.C. | State Politics | NewsObserver.com

Since North Carolina, like 25 other states, rejected Medicaid expansion earlier this year, many of the state's poorest residents will go without insurance despite the national health insurance law that was intended to slash the number of uninsured Americans.

The law also called for the poorest of the uninsured to be covered by expanding Medicaid. The federal government promised to cover the full cost of the expansion for the first three years and at least 90 percent in later years.

But last year, when the U.S. Supreme Court upheld the constitutionality of the law, it also said that states couldn't be forced to expand Medicaid. Every state in the Deep South except for Arkansas rejected the Medicaid expansion. Like North Carolina, most of those states are led by Republican governors who are philosophically opposed to the Affordable Care Act.

Because so many Southern states rejected Medicaid expansion, two-thirds of poor blacks and single mothers and more than half of low-wage workers who are currently uninsured in the United States are left without insurance, according to an analysis by The New York Times. The government will not penalize people for not having insurance if they could have been covered by Medicaid in states that aren't accepting the expansion.

Opting Out Of Medicaid Expansion: The Health And Financial Impacts – Health Affairs Blog

The Supreme Court's decision to allow states to opt out of Medicaid expansion will have adverse health and financial consequences. Based on recent data from the Oregon Health Insurance Experiment, we predict that many low-income women will forego recommended breast and cervical cancer screening; diabetics will forego medications, and all low-income adults will face a greater likelihood of depression, catastrophic medical expenses, and death. Disparities in access to care based on state of residence will increase. Because the federal government will pay 100 percent of increased costs associated with Medicaid expansion for the first three years (and 90 percent thereafter), opt-out states are also turning down billions of dollars of potential revenue, which might strengthen their local economy.

Surely you are aware of the refusal of many Republican Governors to provide for the health needs of their poor. This is a significant portion of the 'ObamaCare' discussion and debate. It is really not possible to be an informed participant in the discussion and not be aware of these decisions and the consequences of the partisan grandstanding, in my view.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Rep. Josh Miller, recipient of significant government assistance, opposes Medicaid expansion in Arkansas | Max Brantley | Arkansas news, politics, opinion, restaurants, music, movies and art

The enlistment of roughly half the Republican legislative delegation in implementation of Obamacare's Medicaid expansion is remarkable. Republicans tend to fall by faith in opposition to bigger government investments in the well-being of poor people.

But some of the faithful hold firm. I was drawn to Rep. Josh Miller, a Republican legislator from Heber Springs, who orated against the private option Medicaid expansion last week. He invoked FDR's New Deal — a "hand up," he said, not a "handout."

Miller is of interest because he's a well-known beneficiary of federal government support himself.

Miller, 33, was on an alcohol-fueled drive with a friend about 11 years ago (he can't remember who was driving) when their pickup plunged off a ravine near Choctaw. He was rescued, but suffered a broken neck and was paralyzed. Miller was uninsured. What young, fit man needs health insurance, he thought then. (He had some reason to know better. Not long before, he'd broken his hand in a fight and had to refuse the recommended surgery to fix the injuries properly because he was uninsured.)

Read the article, if you have the stomach for such a huge dose of hypocrisy.

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Specializes in ICU.

I'm surprised no one has talked about how much costs have gone up for us! I get that we are patient advocates, but how about us as relatively well-off professionals? Have any of you all done the calculations to see what your premium would be if you had to use ACA coverage?

It's horrible. I used a calculator and to get the silver plan, I'd be expected to pay over $300/month. The estimated deductible that site gave me with the silver plan was around $2900 (holy crap!) and it was an 70%/30% plan. Honestly, I don't know why anyone in the world would pay for health insurance if the out of pocket costs WITH insurance are going to be that high. I paid less than that for private insurance that covered 100% of most things after the deductible was met, and the deductible was only $500. ACA insurance is absolutely prohibitively expensive compared to what private insurance used to be - you know, before private insurance raised their premiums because they got paranoid about the ACA. I'm sure if I was really poor the ACA would be awesome - but I make $20/hr and that puts me in a very high bracket according to what the ACA is looking for. For anyone who is NOT dirt poor, the ACA coverage increases costs astronomically.

Fortunately, I have insurance through my employer and I don't have to get ACA coverage, which would now be cheaper than the wonderful private insurance plan I used to have, though it would cost me a ton more in the long run. My work insurance is awful, too - it's 80%/20%, which is better than the ACA silver plan but not by much. I had a procedure done this year, and while I would have paid only $500 for it and then nothing else under my old plan, now I'm paying $800 and then 20%. I would have paid for the entire thing out of pocket if I had the ACA silver plan because the procedure was less than $3000 - so I would not have met my deductible yet and my insurance would not have kicked in. How is that supposed to be affordable?!

The only good thing about the ACA, in my opinion, is the free preventive care that came along with it. I also get my birth control for free now instead of paying a $35 copay, so that's good, but I am honestly disappointed with the rest of it, and I wish that "affordable" meant affordable for everyone, and not just affordable to people who are truly poor. How about us lower middle class people - we have expenses and could use a little help on our healthcare costs too.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
I'm surprised no one has talked about how much costs have gone up for us! I get that we are patient advocates, but how about us as relatively well-off professionals? Have any of you all done the calculations to see what your premium would be if you had to use ACA coverage?

It's horrible. I used a calculator and to get the silver plan, I'd be expected to pay over $300/month. The estimated deductible that site gave me with the silver plan was around $2900 (holy crap!) and it was an 70%/30% plan. Honestly, I don't know why anyone in the world would pay for health insurance if the out of pocket costs WITH insurance are going to be that high. I paid less than that for private insurance that covered 100% of most things after the deductible was met, and the deductible was only $500. ACA insurance is absolutely prohibitively expensive compared to what private insurance used to be - you know, before private insurance raised their premiums because they got paranoid about the ACA. I'm sure if I was really poor the ACA would be awesome - but I make $20/hr and that puts me in a very high bracket according to what the ACA is looking for. For anyone who is NOT dirt poor, the ACA coverage increases costs astronomically.

Fortunately, I have insurance through my employer and I don't have to get ACA coverage, which would now be cheaper than the wonderful private insurance plan I used to have, though it would cost me a ton more in the long run. My work insurance is awful, too - it's 80%/20%, which is better than the ACA silver plan but not by much. I had a procedure done this year, and while I would have paid only $500 for it and then nothing else under my old plan, now I'm paying $800 and then 20%. I would have paid for the entire thing out of pocket if I had the ACA silver plan because the procedure was less than $3000 - so I would not have met my deductible yet and my insurance would not have kicked in. How is that supposed to be affordable?!

The only good thing about the ACA, in my opinion, is the free preventive care that came along with it. I also get my birth control for free now instead of paying a $35 copay, so that's good, but I am honestly disappointed with the rest of it, and I wish that "affordable" meant affordable for everyone, and not just affordable to people who are truly poor. How about us lower middle class people - we have expenses and could use a little help on our healthcare costs too.

I did. That is my current option. I didn't experience any significant 'sticker shock'. The rates were actually right in keeping with what I have paid in the past, but for better coverage.

My guess is that you were never a participant in the health care private policy market before.

Do you have any idea what your monthly premiums are for your employer plan? The total premium?

The fact that health insurance is ridiculously expensive is a large part of the reason that many of us would prefer to take 'profit' right out of the equation and move toward a single payer, Medicare for all sort of remedy.

I have had, historically, private health insurance policies a number of times over my professional history. They were always lean on coverage and heavy on copays and deductibles. I particularly enjoyed the time when I really needed the coverage on my ridiculously expensive plan that offered no preventative or maintenance care and included high deductibles and copays and the company cancelled my policy when I became acutely ill and required extensive surgery and aftercare. I was uninsured for a spell after that because, well, because I then had a 'pre-existing' condition and the insurance industry had NO INCENTIVE to provide any sort of policy for me, no matter how unaffordable it might have been.

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Specializes in Critical Care.
I'm surprised no one has talked about how much costs have gone up for us! I get that we are patient advocates, but how about us as relatively well-off professionals? Have any of you all done the calculations to see what your premium would be if you had to use ACA coverage?

It's horrible. I used a calculator and to get the silver plan, I'd be expected to pay over $300/month. The estimated deductible that site gave me with the silver plan was around $2900 (holy crap!) and it was an 70%/30% plan.....

I have done the calculations and I would pay less with an ACA plan. I have also purchased many individual plans in the past and would save even more with an ACA plan compared to what used to be available on the individual market.

The average cost for a family insurance plan prior to Obamcare was $14,000 per year, with mean deductible amount of around $3,000. A similar plan under the ACA is significantly cheaper.

One thing to remember about individual plans is that unlike group plans there were very few measures to hold insurers to their end of the bargain. A congressional inquiry found that over a 3 year period insurers denied 1 out of every 7 claims in the individual market, not surprisingly these were more often than not large claims. Which means it makes no difference what the deductible was, there is no point at which the insurer will start paying the bills in many cases. Denying those claims saved many millions per year, a savings they no longer have which isn't really a bad thing.

Private insurance didn't "raise their premiums because they got paranoid about the ACA", they changed their plans to meet the requirement that they actually provide insurance coverage which meant they became more like group plans, which cost more because they are worth more. The ACA doesn't allow insurers to raise prices due to paranoia since they now have to meet actuarial value requirements.

I keep hearing how supposedly everyone in the individual market are getting less for more money, yet I don't know of a single verifiable example, can you present one?

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It's horrible. I used a calculator and to get the silver plan, I'd be expected to pay over $300/month. The estimated deductible that site gave me with the silver plan was around $2900 (holy crap!) and it was an 70%/30% plan.

i don't understand....that isn't bad....

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014 - CBO

The ACA is decidely NOT a mess, not too expensive to survive, and not the end of some pie in the sky conservative world.

If the Republican leadership in Congress were actually successful in repealing the law, they would replace it with something which looks very much like the ACA.

It is time to move on focusing not on hyperbolic criticism and whining but rather on realistic and reasonable ways to make the law better.

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