Why I cannot hate the Affordable Care Act (ACA)

There was a time when I would've considered the ACA unnecessary. That I would've been annoyed by it. This was also a time where I had little to no interest in politics. It's funny how life has a way of humbling a person and teaching them something new about themselves on a regular basis. This is a story about how I ended up needing the help in order to make myself better. Nurses Announcements Archive Article

"Well why didn't you just get a new inhaler?" I felt a sinking pit in my stomach. I was at a follow up visit to my doctor after ending up in the ER a few weeks before because bronchitis had made my asthma worse and I couldn't breathe. The first thing my doctor asked me was where my inhaler was when this had happened. After all, that was in my plan. I tried to explain to her that I only had one inhaler and it had been stolen the week before when I was riding the bus. Somehow, despite my explanation she didn't understand that since I was uninsured at the time, I just couldn't afford a new one. It was only after the ER trip that a friend of mine had pity on me and bought the inhaler for me.

I lost my insurance in April 2012 because I had been working at a call center that had outsourced its customer service department overseas. This was my fourth lay off in about six years. The whole time I had been trying to go back to school but in playing musical jobs I had never managed to do so. I decided to make school my focus and work secondary and deal with it.

Because I have asthma, I've never been able to get insurance without going through my work before. COBRA would've cost me over six hundred a month, and while my state had opened a high risk pool, it was still too expensive. My NP was awesome and made sure I got refills of my medication before I lost my insurance and gave me a list of community services for when I did lose it, because she knew I wouldn't be able to come back afterwards.

I did everything I could to make sure I would be taken care of. I signed up for a prescription plan at a local pharmacy, I found local clinic that was free, run on community donations. Still there are things that free clinics couldn't handle. Waiting all week to see a doctor because you got sick on Sunday and the free clinic is only open on Saturday isn't helpful when you're so sick you can't breathe. The doctors are volunteers so there's no guarantee of continuous care. In fact, the push is to get you into a local public health or community clinic, but they often were not taking new adult patients or were an hour drive away.

It was about a month after I lost my insurance when I found a lump on my right side, along the edge of the breast tissue. The free clinic provided me a referral but when I called the places they suggested I was turned away. I was told I was too young, that the office no longer provided services, or that they were out of funds for the year. I continued to fight to find a way to access services, but without a referral from a PCP I was getting nowhere. I finally took the time to bus out to one of the few clinics taking patients. They contacted a local imaging center attached to a public hospital to get me in. This started in June, I was finally in for imaging in October. In November I would get a biopsy and find out it was benign. It took me six months from start to finish to find out what was there.

It would be another year before I would get insurance again. In that time I ended up in the ER enough times the doctors started to recognize me. There really wasn't anything either of us could do. I couldn't manage my health without being able to afford regular doctor's visits and medication and they couldn't make a solution appear out of thin air. My wisdom teeth got infected and had to be removed but had to wait two months for a dentist who would help. I was on antibiotics so long I ended up with a GI infection. Bronchitis, allergic reaction, a set of second degree burns from how bad at cooking I can be. They got to deal with it all, despite the fact that most of these things were preventable.

All if this changed in January of last year. I live in one of the states that approved the Medicaid expansion and set up their own healthcare exchange. I was there on day one to shake hands with the Governor, tell him my story, and sign up. I stood up with him to others to encourage them to use the exchange as well. It is the only day of class I've missed since I started back.

Because of the Affordable Care Act I was able to get needed blood work that I had not been able to afford. Reliable access to medication. The first thing my PCP did, remembering how just a few months earlier I had ended up in the ER because I didn't have an inhaler was make sure to get me a prescription for one so I had a backup. One thing I know is I appreciate the opportunity more than I could ever express.

I know there are naysayers out there who will tell me that those things are not really free and that someone has to pay for them. One day I'll graduate and that person will be me. I seriously hope that I am paying to make sure someone gets the care they need with the money I pay into the system. It's saner than paying for what happens when they can't. The system we have isn't perfect, but it can only get better if we put effort into it.

Specializes in E/R, Med/Surg, PCU, Mom-Baby, ICU, more.

So I take it you believe we should guarantee that people can see whatever doctor they want and have it fully covered under any insurance plan?

I believe that you should be able to have the freedom to do what you want which ranges from having no medical insurance to choosing any type of medical insurance policy you want.

Specializes in E/R, Med/Surg, PCU, Mom-Baby, ICU, more.

All the FAQ's did was to further expand on that same statement, mainly in an attempt to un-spin the misleading descriptions of their report that were circulating.

Read the entire Appendix C. It has pearls such as this: "Subsidies that help lower-income people purchase an expensive product like health insurance must be relatively large to encourage a significant proportion of eligible people to enroll. If those subsidies are phased out with rising income in order to limit their total costs, the phaseout effectively raises people's marginal tax rates (the tax rates applying to their last dollar of income), thus discouraging work.

Specializes in Critical Care.
"Screening" for CVA's? The only time you get warning for an upcoming CVA is by having a TIA which is usually due to a stenosis secondary to plaque. They don't do carotid ultrasounds routinely unless you get a TIA. Some ischemic CVA's are due to a thrombus and no one can predict a clot developing and moving. Some have gone their whole lives without an MRI or CT scan of their head so aneurysms or an AVM can happen suddenly.

A known TIA or CVA is actually only one of a number of indications for carotid U/S, and carotid U/S is not the only way we screen for and manage CVA risk, which includes managing a number of risk factors such as HTN, DM, etc.

Specializes in Critical Care.
I believe that you should be able to have the freedom to do what you want which ranges from having no medical insurance to choosing any type of medical insurance policy you want.

If we want to introduce a system where people can opt-out of all healthcare and be legally held to that opt-out, then I'm all for allowing those same people to opt-out of paying into that system. As far as I know, no such opt-out system exists.

Specializes in Critical Care.
However they failed to mention that employers were reducing workers hours to part time so that they would not be required to furnish insurance. Cause and effect.

A good reason to completely disconnect health insurance and employment.

Specializes in E/R, Med/Surg, PCU, Mom-Baby, ICU, more.
No ones forcing anyone to do anything. The fact that you think so, you are grossly over representing my abilities

Its a message board, and last time I looked we are allowed to express our opinions.

Oh I see. You just like to voice opinions about how a country should be run despite not living in it.

Specializes in Critical Care.
Read the entire Appendix C. It has pearls such as this: "Subsidies that help lower-income people purchase an expensive product like health insurance must be relatively large to encourage a significant proportion of eligible people to enroll. If those subsidies are phased out with rising income in order to limit their total costs, the phaseout effectively raises people's marginal tax rates (the tax rates applying to their last dollar of income), thus discouraging work.

The main difference between the tax credits provided by the exchange subsidies and the tax credits provided to those who get their insurance through their employer is that the tax reductions for those who get their insurance from their employer are regressive; the more you make (the less you need the tax reduction), the higher the tax reduction which is extremely wasteful. With the exchange subsidies the amount of tax revenue we are losing is limited to only those who really need it, which would seem to make much more sense. How would you suggest treat taxes related to health insurance?

Specializes in E/R, Med/Surg, PCU, Mom-Baby, ICU, more.
A good reason to completely disconnect health insurance and employment.

Eventually you do Single-payer health care but you don't do it while your economy is in shambles. Obama was foolish doing this at this time.

Also from your CBO link:

"CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 per cent to 2.0 per cent during the period of 2017 to 2024, almost entirely because workers will choose to supply less labor ..." (bolding mine)

As Muno noted, the expectation is not that people are going to "lose" their jobs; people who are currently working only in order to maintain insurance coverage will choose to work part-time or not at all (in their current jobs, at least). Choosing to reduce your work hours or leave your job entirely is not "losing" your job. The jobs will still be there, and people who need to work (perhaps many of the currently unemployed) can be hired into them. What part of that is so hard to understand?

However they failed to mention that employers were reducing workers hours to part time so that they would not be required to furnish insurance. Cause and effect.

And how many employers actually did that? There was so much backlash against employers that even stated they might do it rather than look at other options. The more common response was to raise prices or stop providing insurance.

Specializes in Critical Care.
Eventually you do universal healthcare but you don't do it while your economy is in shambles. Obama was foolish doing this at this time.

Obamacare is not universal healthcare. There's good reason to believe that the amount we spend on healthcare, and it's resulting negative impact on the economy, is far more due to our lack of a universal system, which is far cheaper to administer, than it is to moving to much towards a system that is universal through all stages of a disease process, not just when it becomes it's most expensive. Reducing the strain that healthcare costs put on the economy is actually one of the best things you can do in a bad economy.

It's not what I would consider moral, but I'd prefer a system that was at least consistent to our current one. Either we guarantee treatment of a condition, or we don't, but this half-and-half thing is idiotic.

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

So we all understand that some are terribly unhappy with "Obamacare".

What are the proposed improvements or what is the preferred method to enable all American citizens to gain access to affordable preventative and acute health care in this country?

I'm okay with the notion of repealing the ACA.

Will it be replaced?

Will insurers again be allowed to disqualify those with pre-existing conditions?

Will parents be able to keep their young adult children on their policy regardless of college attendance?

Should we get rid of EMTALA in effort to reduce our health care costs as part of GDP?

Will the amount of insurance premiums spent on actual health care vs. "overhead" go back down if we repeal the ACA? Will the insurer get to keep 25, 30, 40% of premiums to pay for executive salary and bonus packages again?

Will we see a return to the previous pattern of rate and cost hikes (>119% between 1999 and 2008) when we repeal the ACA?

We understand that so many people are so unhappy with the ACA and want it repealed.

We simply don't understand what the plan is after the repeal. We don't understand what improvements or replacements are planned.

Will it just go back to the way it was before?

Perhaps rather than calling liberals names and trying to incite agravation and irritation some concrete ideas for improving our health insurance system could be explored by those who hold such deeply felt animus for the ACA.

In the absence of that we are left with the notion that some Americans are just too poor or too ill or too stupid and they should be allowed to die because that is what is most fiscally responsible for the American government and society.