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.
"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.
I'm just not sure that this would be any different today unless you qualify for medicaid off the bat! Chances are the premiums and out of pockets would be unaffordable today, plus most states require you to give any property you have to them after you die! So medicaid really isn't free unless you are totally destitute and own nothing, which most disabled nurses probably aren't! Most of us probably have a house, some emergency savings and retirement savings that would have to be drawn down to qualify for medicaid before we would qualify for medicare! How many of us could afford cobra premiums if we were unemployed or disabled?
Unfortunately I see this a lot working in LTC. We have more than a few residents that I know of that have lost their family homes because the asset was more than the state allowed. I also know at least two that currently have a lien on their property by my employer for non-payment of the balance that wasn't covered by medicare or their insurance. These are the ones I am aware of because either the resident or their family has told me about it, since I have nothing to do with the billing end I can pretty safely assume there are probably more in the same boat that I do not know about. I think it's sad and pretty pathetic to work hard your whole life and have nothing to show for it at the end.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Unfortunately I see this a lot working in LTC. We have more than a few residents that I know of that have lost their family homes because the asset was more than the state allowed. I also know at least two that currently have a lien on their property by my employer for non-payment of the balance that wasn't covered by medicare or their insurance. These are the ones I am aware of because either the resident or their family has told me about it, since I have nothing to do with the billing end I can pretty safely assume there are probably more in the same boat that I do not know about. I think it's sad and pretty pathetic to work hard your whole life and have nothing to show for it at the end.
Sadly most Americans will work hard their whole life and have little to show for it in terms of financial wealth. That is now the norm in Murika
Specializes in ER - trauma/cardiac/burns. IV start spec.
I am ready there. I have Medicare and Tricare and I have been without a PCP for 3 years. No one in my area is accepting new patients with the insurance I have. I have severe latex allergies, MCA, high blood pressure, cardio myopathy, chronic B12 deficiency, chronic low-mag, diabetes and have had a cardiac oblation x3. I do have a chronic pain management doctor but he cannot address any of my other problems. I have to go to a local doc in the box to get my inhalers refilled. I have developed dental problems due to overuse of benadryl and I do not have a safe dentist to go to in my area and driving long distances is out of the question.
I worry that my CPM doctor is going to start dropping medicare patients. Without him I would not be able to get out of the bed to do anything.
Specializes in Management, Med/Surg, Clinical Trainer.
I am ready there. I have Medicare and Tricare and I have been without a PCP for 3 years. No one in my area is accepting new patients with the insurance I have. I have severe latex allergies, MCA, high blood pressure, cardio myopathy, chronic B12 deficiency, chronic low-mag, diabetes and have had a cardiac oblation x3. I do have a chronic pain management doctor but he cannot address any of my other problems. I have to go to a local doc in the box to get my inhalers refilled. I have developed dental problems due to overuse of benadryl and I do not have a safe dentist to go to in my area and driving long distances is out of the question.
I worry that my CPM doctor is going to start dropping medicare patients. Without him I would not be able to get out of the bed to do anything.
Very sad. Thank you for your service.
For those not aware, once a military retiree goes on to medicare then they are no longer allowed to see the MDs on base. They must use civilian doctors for their care and the MDs can refuse to accept patients with that insurance.
The MDs refuse to accept the Medicare and Tricare because they pay pennies on the dollar for care.
I have seen this first hand -- a bill was for $10,000.
The patient paid $180.00, Medicare paid $2,000 and Tricare paid $500.00. The rest the hospital and doctors have to write off. This is why MDs refuse to accept certain plans including Medicare and it is also why going to a single payer would be a huge curve.
Before a single payer could be implemented a whole new payer system would have to be constructed and cost controls put into place. We know the GOV sets values for what they will pay and what they can afford to pay for procedures, based on their algorithms and premiums that they take in. That said we can see real quick big changes would need to be made, as the imbalance is huge.
Yes we talk about MD salaries would have to go down and let's be real nurses, RTs and other salaries would need to go down as well....as a host of other costs to stay in line with what the GOV can pay..either that or vastly increase what we pay into the system.
House lawmakers pushing for military retirement reform on Wednesday had to fight off opposition from veteran colleagues who warned against moving too fast and upsetting current service members.
The proposal, which would trim payouts for troops who stay 20 years or more but give all service members federal contributions to a 401(k)-style investment plan, follows an outline of major changes developed by the Military Compensation and Retirement Modernization Commission.
But during debate on the annual defense authorization bill, several members of the House Armed Services Committee said panel leaders have not gotten enough feedback from troops and their families on the plan.
Iraq War veteran Rep. Chris Gibson, R-N.Y., pushed instead for a year-long review of the reform plan, requiring input from current service members and information from Pentagon officials on potential policy changes.
Specializes in Critical care, tele, Medical-Surgical.
My daughter chose a Bronze Plan with a total possible yearly premium plus deductible of $6,500.00.
She is gambling that she will remain healthy. If so she will save compared to the silver plan premiums. She keeps more than enough in savings to pay up to the yearly maximum if she ie sick or injured.
After her hours were cut 13 years ago she could not get affordable insurance at all because she was overweight. She lost that weight in 2005 and has kept a normal weight since, but was considered to have a pre-exhisting condition. Any policy she could get had premiums higher than her income.
Because her job has been part time for more than a decade she also walks dogs. She has keys to peoples condos and apartments and walks their dogs when they want her to.
With her total income she can get a Bronze plan. It is not available for people who qualify for a subsidy. They must purchase a Silver Plan with lower deductibles. The total yearly maximum would be the same.
For individuals and families with any equity such as a home, business, savings, and/or investment income having insurance will likely prevent bankruptcy if they have an expensive illness or injury.
I encourage and assist my friends, neighbors, and family to have a primary care provider they trust. That person will be such a blessing if there is a serious illness or emergency.
I sometimes give them phone number, sit with them while they are on hold, encourage them if the provider is not accepting new patients, and go through the process until they have an appointment. If they ask I go with them for the first appointment, once even into the examination room.
The listen the what they want to tell me and try to answer any questions they have.
After the first visit most providers have email appointments and email communication with the provider.
I think too many people who lived without insurance for a long time need help accessing healthcare.
Sometimes they help others after establishing a relationship with a nurse practitioner or physician.
"I think too many people who lived without insurance for a long time need help accessing healthcare."
The problem with the above statement is that insurance DOES NOT equal access to healthcare. As I shared in the past, a doctor, hospital, pharmacy, etc. is under ZERO obligation to accept any insurance. If access equal ability to afford, and they don't accept Obamacare insurance, OR only specific tiers of Obamcare insurance, then there's no access.
"I think too many people who lived without insurance for a long time need help accessing healthcare."
The problem with the above statement is that insurance DOES NOT equal access to healthcare. As I shared in the past, a doctor, hospital, pharmacy, etc. is under ZERO obligation to accept any insurance. If access equal ability to afford, and they don't accept Obamacare insurance, OR only specific tiers of Obamcare insurance, then there's no access.
Thank you.
There have always been individual providers who don't accept certain insurances, just as insurance companies pick and choose which providers they will cover. However, having insurance coverage, "even" through the ACA, gives one a lot more access to healthcare than not having insurance. People who previously had no coverage are likely to be able to find someone who will be happy to treat them. I have a v. hard time believing that the situation is as dire as you like to suggest.
I understand that we only pay a portion. I'm talking about these people on these employer plans that still pay $800 a month. What exactly is the employer contributing.
Specializes in Critical care, tele, Medical-Surgical.
Good day:
"I think too many people who lived without insurance for a long time need help accessing healthcare."
The problem with the above statement is that insurance DOES NOT equal access to healthcare. As I shared in the past, a doctor, hospital, pharmacy, etc. is under ZERO obligation to accept any insurance. If access equal ability to afford, and they don't accept Obamacare insurance, OR only specific tiers of Obamcare insurance, then there's no access.
Thank you.
I agree with you. It is not easy. That is why I stayed with more few people as they called doctors listed as accepting the plan. One woman made many many calls to be told, She is not accepting new patients at this time." After the first two she asked if another doctor in the practice was taking new patients.
Finally she had an appointment for the free yearly preventative care visit.
She now had a primary doctor. If she gets sick she can go to one of our best hospitals where he is on staff. Of course she hopes not to need hospitalization.
I made sure to show each person who was happy for my help to point out the urgent care clinic they can go to if they can't get an appointment when sick.
In my area the plans I know send a booklet with all available primary practitioners and hospitals. An updated list is on line too.
I wouldn't help a person call a practitioner who is not in the plan, but many accept the insurance who are not taking new patients.
Two people I know have the same doctor who is new to to his city.
I'm just saying that sometimes nurses can help our friends, neighbors, and family members access care. If they want the help.
I agree with you. It is not easy. That is why I stayed with more few people as they called doctors listed as accepting the plan. One woman made many many calls to be told, She is not accepting new patients at this time." After the first two she asked if another doctor in the practice was taking new patients.
I had that problem in 2005, when my PCP retired, and I had insurance. It's not a new issue.
kbrn2002, ADN, RN
3,970 Posts
Unfortunately I see this a lot working in LTC. We have more than a few residents that I know of that have lost their family homes because the asset was more than the state allowed. I also know at least two that currently have a lien on their property by my employer for non-payment of the balance that wasn't covered by medicare or their insurance. These are the ones I am aware of because either the resident or their family has told me about it, since I have nothing to do with the billing end I can pretty safely assume there are probably more in the same boat that I do not know about. I think it's sad and pretty pathetic to work hard your whole life and have nothing to show for it at the end.