Why I cannot hate the Affordable Care Act (ACA)

[jaycam]

"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.

[SC_RNDude]

How are those ideas different from what we currently have?

We have HCAs

We do have health insurance exchanges

etc

I'm not pretending that there hasn't been "discussion", it is just not clear how the suggestions are different from the status quo or different from what was available before the ACA?

It is difficult to understand the depth of the animus about the ACA when the reported conservative alternatives look a great deal like the ACA. Why hate the ACA when it could just be tweaked a bit to better reflect the conservative heritage that it enjoys?

Above, you just said I was a propagandist because I float ideas without participating in discussion.

As for how the discussed ideas would be different? Here is a link to just one if those discussions. If you think these ideas are similar to what we have now, I don't think I can help you understand any better.

https://allnurses.com/nursing-activism-healthcare/health-care-law-793268-page2.html

[jaycam, RN]

And toady, the Supreme Court rules 6-3 in favor of leaving the subsidies intact for those living in states refusing to implement.

[toomuchbaloney]

Above, you just said I was a propagandist because I float ideas without participating in discussion.

As for how the discussed ideas would be different? Here is a link to just one if those discussions. If you think these ideas are similar to what we have now, I don't think I can help you understand any better.

https://allnurses.com/nursing-activism-healthcare/health-care-law-793268-page2.html

You are quite correct.

I have followed those threads from the beginning and you apparently cannot explain these positions in a way which helps me to understand them better.

What I read and see in those threads are ideas that are not dramatically different from what is offered in the ACA in a general fashion. The are, IMV, extensions of the fundamental basis of the ACA as developed in the conservative think tank which created it (The Heritage Foundation).

[SC_RNDude]

You are quite correct.

I have followed those threads from the beginning and you apparently cannot explain these positions in a way which helps me to understand them better.

What I read and see in those threads are ideas that are not dramatically different from what is offered in the ACA in a general fashion. The are, IMV, extensions of the fundamental basis of the ACA as developed in the conservative think tank which created it (The Heritage Foundation).

Help me out then. How is this similar to the ACA?

"In a free-market based plan, employers would be getting out of the management of your healthcare. And insurance companies would as well.

Health insurance would be for emergency care and for lack of a better term, "catastrophic" situations only, much like your car, home, life, etc. insurance. For example, you get a cancer diagnosis, the insurance company would give YOU a payout. You then decide on the treatment. YOU are in control of your care, not the insurance company.

This insurance would not be tied to your employment. You would buy this as an individual, and and long as you keep paying premiums, they can't drop you. Insurance companies will set rates by your risk factors, again much like car, home, and life insurance. Instead of doing everything they can to keep unhealthy people away like they do now, now they will be competing for all types of customers.

The consumer will be responsible to pay for routine exams, RX's, diagnostics, etc. They will do this with tax-free Health Savings Accounts. As an employee benefit, employers will contribute to these accounts as well. Your care will be managed by YOU, not your employer and not your insurance company."

[toomuchbaloney]

Help me out then. How is this similar to the ACA?

"In a free-market based plan, employers would be getting out of the management of your healthcare. And insurance companies would as well.

Health insurance would be for emergency care and for lack of a better term, "catastrophic" situations only, much like your car, home, life, etc. insurance. For example, you get a cancer diagnosis, the insurance company would give YOU a payout. You then decide on the treatment. YOU are in control of your care, not the insurance company.

This insurance would not be tied to your employment. You would buy this as an individual, and and long as you keep paying premiums, they can't drop you. Insurance companies will set rates by your risk factors, again much like car, home, and life insurance. Instead of doing everything they can to keep unhealthy people away like they do now, now they will be competing for all types of customers.

The consumer will be responsible to pay for routine exams, RX's, diagnostics, etc. They will do this with tax-free Health Savings Accounts. As an employee benefit, employers will contribute to these accounts as well. Your care will be managed by YOU, not your employer and not your insurance company."

The ACA is moving us away from employer based health insurance at this time.

So, the notion that a patient would receive a lump sum of $ for a specific episode of care...who decides what consitutes a particular dx...is DCIS paid the same as other types of breast cancer?

What happens if the provider charges less than the lump sum paid to the bene? Will the bene have to pay that back?

Will people who get a devastating dx find themselves unable to pay for their premiums when their risk outweighs benefit for the insurer?

Will employers be required to contribute a minimum amount to the HSAs of employees?

Will employers get to opt out of a contribution to an HSA if they believe the employee might purchase an IUD or an abortion with those funds?

Is there a plan for a newly employed and insured person who needs some costly care but does not yet have $$ in the HSA?

[heron, ASN, RN]

Since it seems to me that the free market economy got us into this mess, I have a hard time believing it'll get us out.

Specifically, I don't see how the plan laid ou by SC would benefit lower income people or those whose chronic health issues made them uninsurable before the ACA. Those would have to be some pretty hefty hsa's, especially the employer contributions.

[MunoRN, RN]

https://allnurses.com/nursing-activism-healthcare/obamacare-and-hospitals-949373-page7.html#post8208678

You can go to posts #82 and #85, and then go from there if you want. You may not think the ideas are good, but please don't pretend there hasn't been discussion.

And have you not heard of these ideas and possibilities other places?

The main source of the conservative push towards increasing the use of HSA's comes from John C Goodman, often referred to as the "father of HSA's", he's also the founding President of the NCPA.

Goodman and the NCPA have since split, but they still seem to have similar views on HSA's and neither appears to argue that the expanded use of HSA's under Obamacare falls short of what they were arguing for, and actually Goodman seems to argue we've maybe gone too far:

How Much Of The Cost Should The Patient Bear? - Forbes

You seem to be arguing something completely different, although I'm still not sure how it's different.

[MunoRN, RN]

Health insurance would be for emergency care and for lack of a better term, "catastrophic" situations only, much like your car, home, life, etc. insurance. For example, you get a cancer diagnosis, the insurance company would give YOU a payout. You then decide on the treatment. YOU are in control of your care, not the insurance company.....

....The consumer will be responsible to pay for routine exams, RX's, diagnostics, etc. They will do this with tax-free Health Savings Accounts. As an employee benefit, employers will contribute to these accounts as well. Your care will be managed by YOU, not your employer and not your insurance company."

That's already how it works, that's what a deductible is; the consumer is responsible for paying for all the services they use, up until they reach an amount that exceeds their ability to pay themselves independently. Paying for is independently-payable portion is done through an HSA now more than it ever was prior to Obamacare. Are you saying deductibles (the amount the consumer pays prior to insurance kicking in) are too low under Obamacare?

Neither employers or insurance companies currently "manage" your healthcare, that's what's done between doctors and patients. Insurance companies used to be able to significantly limit the ability of a patient and doctor to manage your care through coverage limitations, which is why Obamacare added a number of coverage mandates which you seem to oppose.

Help me out then. How is this similar to the ACA?

"In a free-market based plan, employers would be getting out of the management of your healthcare. And insurance companies would as well.

I'm all for getting rid of the employer-insurance connection, which is one of the main benefits of moving towards single payer, which is also why I would guess those opposed to single payer aren't pushing the idea of doing away with employers as the main providers of insurance.

The process of making more of a transition away from employer-sponsored insurance raises some issues that would need to be addressed:

The cost of health insurance currently makes up a significant portion of employees' effective income. If we said employers no longer had to pay this cost, how would we ensure that employers are transferring this portion of income to employees so that this doesn't just result in a massive pay cut for employees?

Most likely, the number of people now requiring assistance to purchase insurance of similar value to what they had before would go up dramatically (since they've lost a portion of their income in the form of health insurance). Where would those assistance funds come from? If they come from tax revenue, what tax revenue? If employers have suddenly experienced a windfall of extra money, thanks to now being able to keep at least a portion of what they were paying for insurance, taxing employers to pay for this assistance to purchase insurance would seem to be the most obvious choice, which would leave conservatives now having to argue that we should put a large number of people on government-subsidized insurance and that we would need to raise taxes on businesses to boot, which as you can imagine isn't something conservatives want to to do. (Even though the amount businesses are paying towards insurance wouldn't really change).

[SC_RNDude]

So, It sounds like it is agreed then that the ideas in regards to HSA's that were previously discussed are NOT similar to what Obamacare offers.

[MunoRN, RN]

So, It sounds like it is agreed then that the ideas in regards to HSA's that were previously discussed are NOT similar to what Obamacare offers.

I know of two main sources for talk about HSA's prior to Obamacare, the "National Center for Policy Analysis" and it's founder, John C. Goodman. Both currently appear to agree that Obamacare contains the HSA's as they wanted them, so I'm not sure what you're referring to.

[Mindful, RN]

... you're wrong on the facts

[heron, ASN, RN]

... you're wrong on the facts

Who are you talking to?