So what's going to happen to health care now?

Nurses General Nursing

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So, for better or worse, we have a new President. What do you think will be the future of health care and the future of nursing as a profession? Will we be better off as nurses or worse? Will we be better off as patients or worse?

Not looking for a political argument....god knows we've had enough of those in the past few days. Emotions are running high and we all have opinions. I'm just curious as to what we can expect.

Specializes in Critical Care.

As for what to expect going forward, Trump has already stated that plans on keeping key parts of the ACA, including requiring insurers to cover pre-existing conditions, which effectively also requires some variation of a mandate to be covered, and both Trump and Gingrich have consistently called for everyone to be covered.

Gingrich's plan has been to use tax credits to make insurance cheaper, just like the ACA, but when people opt out of buying insurance and then end up in the hospital they would be placed in high risk pools and their unused tax credits from not buying insurance would be used to cover their costs. The problem with that is these tax credits would only cover a small portion of the healthcare costs of these pools, leaving the need to either just cut off a portion of those people from treatment, or establish a second tier of hospitals and other services that provide a more minimal level of care. One option that's been thrown around is to have non-ICU hospitals to keep costs down for this pool of patients.

Specializes in Hospital medicine; NP precepting; staff education.
The ACA was a nightmare for me due to pre existing health issues so I paid the tax penalties for the first two years. Having insurance through my job with the outrageous deductions made it practically impossible to see a doctor and now 7 yrs later my condition got worse.

A nurse told me her brother died because he couldn't afford the outrageous medical cost. Unless you have good healthcare insurance through your job you were one of the ones paying high amounts of money each month to pay for thisetwho weren't working and due to my pre existing condition it was too expensive so I was like it's not fair if someone doesn't work, they get section 8 rent,food ebt and welfare, health care handed to them.

Even people who weren't born and are not green card holders get to have free healthcare if they visit an emergency room and I don't need to explain the free millions of dollars many undocumented people get through home health due to their special need children formula, diapers,chucks, DME, wheelchairs, supplies, trach gtube vent machines, millions of dollars a year but here I am an American citizen, an LVN is being charged hundreds of dollars a month for my healthcare and the deductions our outrageous.

Mind you prior to the ACA I never had insurance issues with any of my jobs prior to nursing and can't comment on what home health and other non hospital jobs insurance were like prior to the ACA.

ACA helped some people but it was a disaster to many hard working people.

I pay my own rent, food etc and as a new nurse although I can easily get home health jobs most don't offer good health care benefits so it was better to not work and get my serious medical condition fixed first sadly.

Home care is not free, for anyone. Emergency care is not free for anyone. Care in an ED cannot be denied (emergent care) due to lack of insurance or ability to pay, or even immigration status. Not only is that against the law (EMTALA) but unethical to deny (emergent) care to anyone. All parties seen are billed, and if they have insurance it is filed. Our organization works with those who are un- or under-insured and sets up payment plans. We even have a charity program if people qualify (based on income, or lack thereof) which not only takes care of ED visits, but inpatient stays, surgeries, and affiliated practice visits (like Ortho, GI, etc.).

I'm sorry you have been unable to get what you need. I wish you wellness and good luck.

Less pay, less demand, less nurses.

Specializes in Geriatrics, Home Health.
People can also not make enough money to qualify for a health insurance subsidy, yet not qualify for Medicaid. This situation is known as the "Coverage Gap", and a number of people fall into it.

The coverage gap only happens in states that refused Medicaid expansion.

Specializes in Geriatrics, Home Health.
I read somewhere that Ryan wanted to cut medicare and make it private. That would have a huge effect on this industry.

Paul Ryan has admitted that he wants to phase out Medicare for new enrollees, starting next year.

First, Ryan claims that Obamacare has put Medicare under deeper financial stress. Precisely the opposite is true. And it's so straightforward Ryan unquestionably knows this. The Affordable Care Act actuallyextended Medicare's solvency by more than a decade. Ryan's claim is flat out false. Second, I've heard a few people say that it's not 100% clear here that Ryan is calling for Medicare Phase Out. It is 100% clear. Ryan has a standard, openly enunciated position in favor of Medicare Phase Out. It's on his website. It's explained explicitly right there.

Ryan says current beneficiaries will be allowed to keep their Medicare.Says. But after the cord is cut between current and future beneficiaries, everything is fair game. For those entering the system, Ryan proposes phasing out Medicare and replacing it private insurance with subsidies to help seniors afford the private insurance. That is unquestionably what it means because that is what Ryan says. So if you're nearing retirement and looking forward to going on Medicare, good luck. You're going to get private insurance but you'll get some subsidies from the government to pay the bill.

Through all the gobbledygook and bamboozlement, you'll find this line on Ryan's page: "For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs."This means, if you haven't gone on Medicare yet, when you do, you won't get Medicare. You'll get a "premium-support payment" - i.e., a check that will allow you to buy insurance from private insurers. The "support" in the phrase means it won't cover the whole amount. And in any case, rather than Medicare you'll have insurance from an insurance company, which everybody should love because haven't you heard from your parents and grandparents how bummed they were when they had to give up their private insurance for Medicare?

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Love this. I was an advocate of the ACA for that exact reason...it SEEMED that it was going to FORCE competition. Business people and advocates of free market are always screaming to let the markets regulate themselves. In theory the ability to choose insurance would then make insurance cheaper if I have choice beyond my employer. Unfortunately that hasn't been what has happened for many people.

I had a friend who when he initially signed up on the exchanges was quoted something astronomical. He went back on and reapplied and got insurance for less than $100 a month. Don't ask me what he changed but obviously he changed something major!

In regards to what to expect, who knows? The president elect said whatever he needed to say to get into office. I'm not sure he even believed 98% of what came out of his mouth. Further, he isn't a politician and I am not sure he has any earthly idea how things really work in Washington. I think he is going to get one of hell of an education come January 20th.

The coverage gap only happens in states that refused Medicaid expansion.

The point is that people are unable to access health care.

Also, even in states that have expanded Medicaid, it is not that easy to qualify for Medicaid even though one has a very low income if one has more assets than are permissible by Medicaid rules. I live in a state that expanded Medicaid, and there are significant restrictions on the types and amount of assets one may own. Yes, the purpose of Medicaid is to provide health care to poor people, so it is reasonable to impose a limit on the amount of assets one may have in order to be eligible for free health care, but between being in real poverty and making enough money to qualify for an ACA subsidy there are a number of people who are in the middle, not making enough money to receive a subsidy, but having too many assets to qualify for Medicaid (and having too many assets to qualify for Medicaid does not by any means necessarily mean that one is comfortably off), who are faced with paying the entire cost of health insurance themselves, going without health insurance and paying the penalty, or spending down whatever assets they have that are above the Medicaid threshold so they can qualify for Medicaid. Another point is that in some states Estate Recovery applies to health care received through Medicaid, so one's Estate and one's heirs are subject to these provisions after one's death.

I am cautiously optimistic. If the ACA remains as it currently is, we have all heard the horror stories about how premiums are going way up in January. People will not be able to afford those, and would start dropping coverage. Of course, this will be a Catch-22, as they will be fined. Currently, several insurance providers are also getting out of this business, or not expanding coverage as previously planned. That does not bode well for "universal coverage". I also currently know several doctors who are either opting for early retirement, or are not taking Medicare patients. My own MIL, when she moved here to KY, had a terribly difficult time finding a PCP who would take her Medicare insurer. And then it was several months' wait for an initial appt when she did get one to agree to accept her as a patient.

Suffice it to say, I think there are some good things coming if we can get them through Congress. I for one feel that if we can get interstate competition among insurance companies where you can purchase a plan from any insurance company in the country, competition will drive the prices down and make insurance more affordable. I also would like to see the fine for lack of coverage dropped, because I know lots of young, healthy adults who would like to opt for "no insurance coverage" until they are older. Also, I think I would like to see other healthcare models put into place, like clinics managed with a "membership fee", where doctors or NPs offer potential patients an annual plan where they charge an annual fee (say, $1500), and then each visit is only $30 and covers all lab work, diagnostics, etc. In the long run, the doctor knows what his income will be, and people's medical expenses would be a lot more affordable. I am just throwing a random number out there. . . but, I do know that some of these clinics already exist in KY, and are run by Nurse Practitioners. In this regard, there would be more options for nurses to manage care for patients.

I also think this sort of model could be used for lower income people as well, with clinics run on a sliding scale based on income. I have seen this in the past as well. These types of clinics could also be managed by NPs.

I also think employers offering HSA's on a wider basis would be helpful as well.

Obama and the left wing politicians have made a huge mess. What family can afford a $1400/month premium in this economy? My families insurance has gone up, way up, and the coverage is less. The ACA was hastily tossed together and rammed through Congress. Then to top it off, no one read it. "We have to pass it so we can see what's in it, away from the fog of controversy" Speaker Nancy Pelosi. This mess was created in a profoundly partisan way. Any bill that would affect so many should have been passed with full support of Congress, not just the Democrats. They are responsible for this mess and cannot deal with reality. The people have had it with these failed policies. Evidenced by Trump being elected to the White House. Now we will have to go through the cleaning up process. The redistribution of wealth plan has failed. I hope things get better for the people. Those on tight budgets need relief.

Obama and the left wing politicians have made a huge mess. What family can afford a $1400/month premium in this economy? My families insurance has gone up, way up, and the coverage is less. The ACA was hastily tossed together and rammed through Congress. Then to top it off, no one read it. "We have to pass it so we can see what's in it, away from the fog of controversy" Speaker Nancy Pelosi. This mess was created in a profoundly partisan way. Any bill that would affect so many should have been passed with full support of Congress, not just the Democrats. They are responsible for this mess and cannot deal with reality. The people have had it with these failed policies. Evidenced by Trump being elected to the White House. Now we will have to go through the cleaning up process. The redistribution of wealth plan has failed. I hope things get better for the people. Those on tight budgets need relief.

The ACA was not "hastily tossed together and rammed through Congress." There was extended discussion and debate, many elements added and subtracted from the bill, and weeks of hearings held by the Senate Finance committee (I remember, I watched most of them) before it was brought to a vote. There was the same period of time between when the bill was finalized and the vote occurred that there is for every other bill, as prescribed by the rules of the Congress, and, regardless of Pelosi's unfortunate statement, anyone who didn't read the bill prior to voting on it has only her/himself to blame for that.

The final version of the ACA is a mess precisely because the Democrats took out many things that the Democrats wanted, and put in things that the Republicans wanted, in order to create a final bill that would be truly bipartisan and the Republicans would be able to support. The final bill is nothing like what Democrats would have written on their own. And, in the end, after including all kinds of things the Democrats didn't want and the Republicans insisted be included in the bill, the Republicans still wouldn't vote for it, mostly, I believe, so that they can complain about it to their constituents and be able to say that they didn't vote for it. The individual mandate, for instance, was originally a Republican proposal many years ago, and they had been advocating for it for years, right up until the Democrats included it in the healthcare reform bill because it was something they (thought they) knew the Republicans wanted -- and, then, as soon as the Democrats put it in the bill, suddenly the Republicans were opposed to the individual mandate, and they've been complaining loudly about it ever since.

The Republicans made sure that the bill would be a mess that wouldn't work, far different from what the Democrats originally wanted, then refused to vote for it, and now have spent all their time since then complaining that the bill is a mess that doesn't work, and blaming the Democrats for it being "partisan" and reminding everyone that none of them voted for it. The entire process was reminiscent of Lucy holding the football for Charlie Brown. They set up the Democrats; the well-meaning and sincere Democrats, trying to be bipartisan and "team players," made the mistake of trying to work with them, and they've been beating the Dems over the head with the law ever since.

Where do any nurses have pensions these days? Do they have any openings for me?

The federal positions still have a pension as do most state jobs.

The federal positions still have a pension as do most state jobs.

That depends on the state. My state eliminated defined benefit pensions for state employees years ago; there are still a few "old-timers" who are going to be getting a pension, but all new hires have been put into a defined contribution retirement savings (401k-type program) program for many years now. I believe that is true in plenty of other states, also.

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