PRN hours decreased because of the ACA

[kdhunley]

I work PRN at a hospital, usually 36-48 hours per week. We have been told that because of the Affordable Care Act (Obamacare) we can no longer work more than 30 hours a week. While this doesn't officially take effect until Jan. 2015, our hospital is choosing to implement this now.

Of course, you can imagine, we are all upset, particularly those of us who work full-time hours. I choose to work PRN because I get paid more per hour and don't need benefits because I have insurance through my husband's employer.

Our hospital heavily utilizes PRN nurses both dedicated to a particular floor and a float pool. We all feel this is really going to negatively affect patient care and adequate staffing. I am going to find another PRN job to get the hours I need to work each week.

Has anyone else had this experience?

[Jolie, BSN]

jadelpn, I applaud your creative thinking, but most of your suggestions are in violation of Obamacare. I encourage you to Google employer compliance and familiarize yourself with the mind blowing requirements for providing coverage. The reason the employer mandate was delayed was because the rules, as written, were so contradictory as to be impossible to follow. For example, one rule required us to calculate and report (to the IRS) each employees' household income, for the purpose of determining affordability and eligibility for subsidies. The problem is, we don't know that information, and can't legally require any employee to share it with us. We only know what we pay our employee, not what any other member of a household earns, so how can we determine whether any plan we might offer meets the "affordability"" test for any employee?

As for hiring Independent contractors, again, please familiarize yourself with the government's very specific definition. Even if that were feasible, would you want to be a patient or employee in a hospital staffed primarily by temporary agency nurses? Who would provide stability, monitor quality of care and maintain consistency ?

[Jolie, BSN]

Look at it this way. If an employer says "I am putting in $100 a week per employee into a health savings account, it is up to you to go onto the website and apply for coverage within 60 days". $400 a month per employee, $4800 a year. Then you can keep a competative wage. Or a bit more for those who already have coverage from another source

Interesting concept, but requiring employees to shop for their own plans, even with employer money does not meet Obamacare compliance.

[elkpark]

You know what I see the facilities doing next? Not hiring anyone for over 30 hours...so they don't have to give them benefits which the ACA law has made completely legal to do..placing the onus of insurance on the sholders of the employee while the CEO's reap more salaries and year end bonuses to their own pocket. If anyone believes that they (the CEO's) will do the stand up thing and not take advantage of the law and crap on the head of the bedside nurse....I have some beautiful land to build on in the Florida Everglades.

Large numbers of employers were doing this long before anyone even started talking about reforming healthcare, only hiring people into part-time positions in order to avoid paying them benefits. It's been rampant in the business and finance worlds for many years. Provisions of the ACA certainly incentivize more employers to do this, but it's not anything new, and certainly not anything that the ACA "made completely legal." It's always been completely legal.

[herring_RN, ASN, BSN]

I'm not debating unions Brandon: they are irreleant to this conversation. I won't be dragged off topic, but if you'd like to discuss them, there are plenty of other threads.

I encourage you to research how and why employer-based health insurance became common. It has everything to do with government interference in wages and prices and very little to do with unions. It is important to the shifting of responsibility for health care payment (not in a good way) and set the stage for uncontrollable health care inflation.

Important lessons not to be dismissed out of hand.

Health insurance was started by hospitals and the American Hospital Association. It was not the government, although at first it was tax exempt. Now most health insurance corporations are for profit and have a feduciary duty to their shareholders.

The History of Medical Insurance in the United States

... Medical insurance took stride in 1929 when Dr. Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, Texas, realized that many schoolteachers were not paying their medical bills. In response to this problem, he developed the Baylor Plan - teachers were to pay 50 cents per month in exchange for the guarantee that they could receive medical services for up to 21 days of any one year.

With the onset of the Great Depres­sion in the 1930s, many other hospitals followed the model of the Baylor Plan, and medical insurance became much more widespread. Pre-paid health plans enabled consumers to be insured but also benefitted hospitals by giving them steady income despite economic turmoil. However, these single-hospital plans also generated price competition, and to avoid this, community hospitals started to work together in creating health coverage plans.

In 1939, the American Hospital Association (AHA) first used the name Blue Cross to des­ignate health care plans that met their standards. These plans merged to form Blue Cross under the AHA in 1960. Considered nonprofit organizations, the Blue Cross plans were exempted from paying taxes, enabling them to maintain low premiums. Pre-paid plans covering physician and surgeon services, includ­ing the California Physicians' Service in 1939, also emerged around this time. These physician-sponsored plans com­bined into Blue Shield in 1946 and Blue Cross and Blue Shield merged into one company in 1971.

Meanwhile, private, commercial health insurance companies began to develop. In the 1930s, several signifi­cant life insurance companies began to offer health insurance....

http://www.yalemedlaw.com/2009/11/the-history-of-medical-insurance-in-the-united-states/

[Guest757854]

This has nothing to do with accepting change....the OP asked a question and the question was answered what the hospitals are saying to the managers and what the law says.

I don't see where this is not accepting change. The law is clear. Hospitals have KNOWN this for a while and the have a reprieve until next Jan. The hospitals have to give insurance to employees (that they didn't have to before) that work over 30/hrs/wk or 120/days a year. Full Time Employee FTE Calculator - Health Law Guide for Business They have to report to the government their FTE's figured by the government standards, everyone included no exceptions.... http://www.adp.com/tools-and-resources/adp-research-institute/insights/~/media/696C3879BDB14C56A98BE58C1F85E363.ashx

The employer will then be charged accordingly by the government for each employee not covered.

In the past employers LOVED perdiem's that worked a lot of hours. They didn't have to pay benefits, 401K matching, vacation or sick time. These employees filled many FTE vacancies without increasing the FTE budget...which are two different budgets by the way. Paying these employees a little more is actually cheaper than paying benefits...so the hospital saved money.

Now these employees are going to cost the facility money if they work more than 30hrs/wk or 120days/year....so the CEO/hospital don't want to increase what they spend..... so they are going to not let these employees work more that what the law allows without having to pay for them. It's simple.

You know what I see the facilities doing next? Not hiring anyone for over 30 hours...so they don't have to give them benefits which the ACA law has made completely legal to do..placing the onus of insurance on the sholders of the employee while the CEO's reap more salaries and year end bonuses to their own pocket. If anyone believes that they (the CEO's) will do the stand up thing and not take advantage of the law and crap on the head of the bedside nurse....I have some beautiful land to build on in the Florida Everglades.

My opinion and im sticking to it! Gud day! And thaks for you response.

[Esme12, ASN, BSN, RN]

Large numbers of employers were doing this long before anyone even started talking about reforming healthcare, only hiring people into part-time positions in order to avoid paying them benefits. It's been rampant in the business and finance worlds for many years. Provisions of the ACA certainly incentivize more employers to do this, but it's not anything new, and certainly not anything that the ACA "made completely legal." It's always been completely legal.

right....but now if these employees work over 30 hours the hospital has to pay...this particular facility who has been using thee employees to avoid hiring FTE benefited positions will probably work short and cut these hours.

What is so hard about this? I am NOT saying the ACA is bad I merely answered a question with the facts.

Maybe this will help. The blood sucking administrators get to walk all over the working stiff again after taking advantage of them all these years because they finally have to be accountable for these poor workers and give them insurance. Now they have another excuse to be even bigger jerks.

[Esme12, ASN, BSN, RN]

Ack! My apologies. I am just now reaching this part of the thread. I really need to not reply as I read!

thats ok....the discussion started to the cost of the plans...that is not what is being discussed....we are discussing the corporate compliance to the new rules and how it might affect the PRN worker. so, in essence it is still being discussed.

[Jolie, BSN]

herring, I believe you mis-understood my post. I realize that health insurance (originally intended for unforseeable and catastrophic costs) pre dates WWII. EMPLOYER PROVIDED health coverage came about due to federal interference with wage controls during the war. Prior to that time, insurance was chosen and purchased by individuals and families, if desired and affordable. That is an important distinction in the history of events leading to Obamacare.

[wirehead]

I'm not a big of the ACA either but let's have a little respect for math. There were about 47 million uninsured in 2012. The simplest per person cost for healthcare (total cost divided by number of people) is about $8,500 per person per year, or about $400 Billion to provided healthcare to all the uninsured every year, which is 400 times what even conservatives claim the website and advertising costs, far short of even covering the uninsured for one year much less 20.

You're numbers are wrong, your cost per person per year is inflated big-time. All I can tell you is my statement is based on facts presented from someone in a meeting with Kathleen Sebelius just prior to the bill being signed. Oh, in case you were wondering, they were aware that millions would lose their current health plan when the plan rolled out.

The most expensive platinum plan I can find in NJ is $5500 per year and has no deductible and no network limitations.

For a family of 3 based on our specific details, in our county for a platinum plan it would cost us $1,449 per month to come close to our current coverage, this one doesn't have an in network deductible, for $1,229 per month we would have a $1,500 in network deductible.

$5,500 yearly is either an individual plan, or a catastrophic plan.

[jadelpn, LPN, EMT-B]

jadelpn, I applaud your creative thinking, but most of your suggestions are in violation of Obamacare. I encourage you to Google employer compliance and familiarize yourself with the mind blowing requirements for providing coverage. The reason the employer mandate was delayed was because the rules, as written, were so contradictory as to be impossible to follow. For example, one rule required us to calculate and report (to the IRS) each employees' household income, for the purpose of determining affordability and eligibility for subsidies. The problem is, we don't know that information, and can't legally require any employee to share it with us. We only know what we pay our employee, not what any other member of a household earns, so how can we determine whether any plan we might offer meets the "affordability"" test for any employee?

As for hiring Independent contractors, again, please familiarize yourself with the government's very specific definition. Even if that were feasible, would you want to be a patient or employee in a hospital staffed primarily by temporary agency nurses? Who would provide stability, monitor quality of care and maintain consistency ?

Unfortunetely, there are many, many facilites that are staffed primarily by temporary or travel staff. It is cheaper than nurses who have been with the facility for years, therefore are on a higher pay scale.

Most facilities could care less about the stability or consistency aspect. They are dollars driven. And if someone can act the part to keep patient satisfaction scores up, then all the better.

[herring_RN, ASN, BSN]

herring, I believe you mis-understood my post. I realize that health insurance (originally intended for unforseeable and catastrophic costs) pre dates WWII. EMPLOYER PROVIDED health coverage came about due to federal interference with wage controls during the war. Prior to that time, insurance was chosen and purchased by individuals and families, if desired and affordable. That is an important distinction in the history of events leading to Obamacare.

Actually the first health insurance was sold to Dallas texas teachers as a group by Baylor Hospital.

In 1939 Blue Cross-Blue Shield provided hospital and physician office insurance sold to individuals and groups. My grandparents worked at Marshall Fields department store where full time employees were provided Blue Cross insurance as an incentive to be loyal. They worked there 30 years.

[MunoRN, RN]

For a family of 3 based on our specific details, in our county for a platinum plan it would cost us $1,449 per month to come close to our current coverage, this one doesn't have an in network deductible, for $1,229 per month we would have a $1,500 in network deductible.

$5,500 yearly is either an individual plan, or a catastrophic plan.

It's for a platinum plan: New Jersey Health Insurance Exchange | Healthcare.gov