Affordable Care Act -- NOT Affordable

[*Michelle*]

I agree that many doctors would prefer that method, but I don't think that matters. Insurance covers the patient, not the service provider.

 

Do you also object to states requiring auto insurance?

 

States require auto insurance to protect people or property you may injure while driving.  Mortgage companies require homeowner's insurance in order to protect their investment.

 

Neither auto insurance nor homeowner's insurance are required if you don't drive or own a house.  This is the only thing I can think of that you are required to buy simply through the act of being alive.

 

[Lisbeth]

States require auto insurance to protect people or property you may injure while driving. Mortgage companies require homeowner's insurance in order to protect their investment.

 

Neither auto insurance nor homeowner's insurance are required if you don't drive or own a house. This is the only thing I can think of that you are required to buy simply through the act of being alive.

 

Yep, this.

[NicksMama-Zack's Mama Too]

 

Here are the calculators I used:

 

http://laborcenter.berkeley.edu/healthpolicy/calculator/

http://kff.org/interactive/subsidy-calculator/

http://www.gohealthinsurance.com/subsidy

 

 

We're fortunate to live in state that is going ahead with Medicare expansion (ETA: We don't need it, but this is our home. KWIM?). That any state wouldn't is insane to me... I'm not making this as a political statement one way or the other: I'm Canadian and grew up in a very different system and outlook (both political and public) from what I'm experiencing in the US.

 

 

The more I read, the less I know....  Help me out here!

 

How accurate are these calculators?  

 

If all these people are going to be dumped into Medicaid, where all are the doctors to treat them?  I realize that a lot of preventative medicine service have no copay.  I would think that there is going to be a lot of new patients seeking preventative care with general practitioners.  I have read that we already have a shortage of GPs because specialist make more money.

 

Are doctor's required to accept Medicaid?   I know that Obama included a increase in reimbursement rates to encourage doctors to continue to accept Medicaid and that the federal government (via taxpayer dollars) are going to cover those increases.  But at some point, the states have to carry the burden of funding Medicaid.  

 

If increasing the Medicaid roles is the end-game of ACA, then why not just raise income threshold and leave the rest of the market alone?  

 

Does Medicaid end up buying policies and paying premiums, co pays etc. for the people that qualify?  

 

Do all plans, purchased OUTSIDE of the marketplaces and sold in 2014 need to be ACA-compliant? Some people believe this to be true, but I don't know.  I've heard people intending to purchase their insurance the last week of 2013, so they can get a cheaper non-ACA-compliant plan.  It seems like the government is demanding the citizens to purchase more than they want or need.  

[Lisbeth]

I have one friend, and one relative, who have now been told there are going across the board pay cuts so their companies can stay afloat and still comply w obamacare. What a disaster.

[*Michelle*]

Are doctor's required to accept Medicaid?  

 

Nope.

 

[Word Nerd]

States require auto insurance to protect people or property you may injure while driving. Mortgage companies require homeowner's insurance in order to protect their investment.

 

Neither auto insurance nor homeowner's insurance are required if you don't drive or own a house. This is the only thing I can think of that you are required to buy simply through the act of being alive.

 

This.

[NicksMama-Zack's Mama Too]

I was researching the increase of Medicaid reimbursement under ACA and found this comment from a physician explaining why they don't take Medicaid patients.  Again, I wonder where we are going to get doctors to service all these new Medicaid patients?

 

smalldoctor

3/2/2013 9:20 AM EST

 

 

I am a doctor and will tell you that in DC, MD, and VA there are several problems with Medicaid. Number 1: It pays terribly. If you get paid $20 to see a patient but during that time period your rent for your office, office staff salaries, utilities etc.. cost $40, there is no way you can continue to see patients with medicaid. That is why most doctors see medicaid. Number 2: Even when medicaid pays you, it takes a long time to get paid. When we do get paid by medicaid it takes 6 months or more. As a result there is a complete loss of cash flow for the practice to pay your costs Number 3: Too much paperwork and hoops to jump to get things done. Medicaid requires a large amount of paperwork and approval letters to get anything done for your patient. If your patient needs an MRI, medicaid requires a letter, chart notes, hours on the phone to get "approval", a call from the doctor to get a procedure approved. Thus it sucks more of your staff time. If you are getting paid terribly from Medicaid and now because of so much red tape and difficulty to manage a patient you need to hire another staff person who costs $50K a year just to get reimbursed $2000 a year from medicaid, you would be a fool to take it. You would end up out of business.  
 
A common question is why don't all doctors take a few medicaid patients as goodwill? We do but what ends up happening is once the word goes out that a doctor takes medicaid, their office gets flooded with medicaid patients and then it is hard to sustain a practice.  
 
That my friends is the truth.

 

-----------------------------------

 

[Dana]

In retrospect, it would have been cheaper for me to have borrowed money in the student loan program to pay for insurance. But of course I did not know that I would become ill--or that I would have a well paid job out of grad school. Life is a risk.

 

But having been there, I choose not to take the risk now. Yes, we have the financial resources that enable me to make that decision. The medical bill from my grad school days was mine without insurance--as it would have been with insurance. I am not sure I see the logic in your statement "I can pay for insurance I likely can't use." If one has a life-threatening illness (or a less severe one that requires medical care), one will have to pay for hospitals, doctors, etc. anyway.

 

<snip>

 

The thing that concerns me though is when someone doesn't do the small steps to greater health because they are impoverished and cannot afford basic medical care or meds. I would rather subsidize someone's high blood pressure meds than care for stroke recovery.

I firmly believe my MiL died from breast cancer earlier than she would have if she'd had insurance earlier.

 

Dh has had a lot of problems going to the doctor because of cost and his history growing up when his parents couldn't afford much medical care. He ended admitted to the hospital for days when returning home from college because of uncontrolled asthma.

 

A close friend was diagnosed with colon cancer at 26. She died at 32. Having medical insurance helped her get care that enabled her to live long enough that her daughter will have memories of her mother.

 

Here is the blog of a woman who watched her husband die young from a brain tumor.

http://washandtashi.blogspot.com/

They gambled that because they were young and the odds were in their favor, it made more sense to not carry insurance. She speaks eloquently of their experiences including the additional stress on her as a care giver and fighting to get medical care to keep her husband alive a bit longer.

 

I am not thrilled with the ACA. I want universal care like most other first world countries. I want a social support net.

 

I have insurance that is fairly decent. We have still been able to deduct medical expenses on our taxes when itemizing on two different years. Due to my friend's death, I had a colonoscopy at 38 due to some symptoms. I had polyps and have had 3 colonoscopies now. With insurance, we've been tight in those months to pay for our out of pocket in past years. Without insurance, I might have to stretch years between exams. And that's exactly what I know my MIL did.

 

And yes, anecdotes aren't data, but we are talking about real people.

I've worried about preexisting conditions excluding my son from getting insurance as an adult or a cap on expenditures hitting my husband. I love that that's not an issue as long as ACA isn't repealed. I've really enjoyed not having to pay for a mammogram this year (breast cancer killed a couple of my great aunts).

[LMV]

 

Here are the calculators I used:

 

http://laborcenter.berkeley.edu/healthpolicy/calculator/

Estimated annual premium $9360 for our family.  We don't qualify for any subsidies.  It doesn't clarify what our coinsurance is but since it mentions a silver plan I'm presuming it is 30% after we've met the deductible.  It doesn't clarify what that deductible is.

http://kff.org/interactive/subsidy-calculator/

Estimated annual premium $11,690 for our family.  We don't qualify for any subsidies.  30% coinsurance and our maximum out of pocket cost (not including premiums) would be $12,700.  It doesn't clarify what that deductible is before coinsurance kicks in.

http://www.gohealthinsurance.com/subsidy

Estimated annual premium $36,846 for our "family" (we would have to remove two members to qualify as they don't have an option for our family size).  We don't qualify for any subsidies.  I presume that there would be further out of pocket costs on top of this but it doesn't clarify.  If it is based on the silver plan then we would be responsible for 30% coinsurance but this isn't clarified well. 

 

Your three calculators provide vastly different results for our family. [see the results in red in your post above.] When I did this last night I used the link someone had provided to the state specific exchanges and came up with 25,000 annual premiums for a plan with a 2,000 per person/ 4,000 per family deductible.  If/when we reach those points coinsurance kicks in and we would pay 30% of the costs until we reach an out of pocket maximum of 10,000. 

[nmoira]

Your three calculators provide vastly different results for our family.  When I did this last night I used the link someone had provided to the state specific exchanges and came up with 25,000 annual premiums for a plan with a 2,000 per person/ 4,000 per family deductible.  At those points coinsurance kicks in and we would pay 30% of the costs until we reached an out of pocket maximum of 10,000. 

 

I don't think these could be used to calculate total premium, because premiums will vary according to geographical region.

[LMV]

 

I was researching the increase of Medicaid reimbursement under ACA and found this comment from a physician explaining why they don't take Medicaid patients.  Again, I wonder where we are going to get doctors to service all these new Medicaid patients?

 

smalldoctor

3/2/2013 9:20 AM EST

 

 

I am a doctor and will tell you that in DC, MD, and VA there are several problems with Medicaid. Number 1: It pays terribly. If you get paid $20 to see a patient but during that time period your rent for your office, office staff salaries, utilities etc.. cost $40, there is no way you can continue to see patients with medicaid. That is why most doctors see medicaid. Number 2: Even when medicaid pays you, it takes a long time to get paid. When we do get paid by medicaid it takes 6 months or more. As a result there is a complete loss of cash flow for the practice to pay your costs Number 3: Too much paperwork and hoops to jump to get things done. Medicaid requires a large amount of paperwork and approval letters to get anything done for your patient. If your patient needs an MRI, medicaid requires a letter, chart notes, hours on the phone to get "approval", a call from the doctor to get a procedure approved. Thus it sucks more of your staff time. If you are getting paid terribly from Medicaid and now because of so much red tape and difficulty to manage a patient you need to hire another staff person who costs $50K a year just to get reimbursed $2000 a year from medicaid, you would be a fool to take it. You would end up out of business.  

 

A common question is why don't all doctors take a few medicaid patients as goodwill? We do but what ends up happening is once the word goes out that a doctor takes medicaid, their office gets flooded with medicaid patients and then it is hard to sustain a practice.  

 

That my friends is the truth.

 

-----------------------------------

 

In our state foster children are covered through Medicaid but we've always added our foster children onto our insurance as soon as allowable because we have run into providers who will not accept Medicaid.  I think pediatricians in general often get guilted into taking Medicaid because they feel badly turning away a child. The reality is that something has to give.   Our children's pediatrician handled this in an interesting way. She continued to bill Medicaid/Medicare but will not bill other third parties.    We pay upfront when we see her and then submit to my husband's plan for reimbursement.  She gives a discount on any charges paid in full at the time of visit and with that we usually get reimbursed most of the visit cost by our insurance.  We're happy to pay a little more because she is amazing.  The way she explained it she was unable to drop Medicaid because she worried with those children if not her then who?  If she streamlined and cross subsidized  in other areas she was able to make it work.  Or at least she has for the past six years.  I'm sure she would admit she is very uncertain regarding the future.

[mommymilkies]

They don't intend to pay.  The bill is more than they can afford or are wiilling to budget in, no matter where they are treated.

 

Since the law requires that the ER give a certain amt of care without demanding cash up front, they go there. The hospital writes the bill off and gets enough profit off of those who do pay to cover the freeloaders.

 

I used to work at a place where a supervisor would survey incoming workers for injuries. They'd injure themselves over the weekend in high risk activities, then come in and claim it was done at work, so that workman's compensation would pay 100%. These workers all had good health insurance...a simple co-pay and everything else was covered 100%.  My conclusion is that a fraction of our population wants a SugarDaddy to take care of everything rather than pay even a dollar out of their own pocket. 

Yikes.  I used to work emergency and med/surg and never saw that.  It's ridiculously difficult to get Workers comp to cover anything here in IL or with my Mom's injury in OH.  I was at work on the floor and my knee was injured (torn ligament in knee)in the presence of two nurses and a nursing supervisor.  They sent me down to the ER to get it x-rayed and looked at, then I was sent back up to work on crutches and told Worker's Comp wouldn't cover it and I had to get back to work.  It's crazy.  I was a single mom with 2 kids, so you know I could totally afford that bill.

 

Edited: Used the wrong state abbreviation! My head's in sickies land today.

[LMV]

I don't think these could be used to calculate total premium, because premiums will vary according to geographical region.

The calculator I used last night (not one of the three you linked above) provided a premium for our state and county. The premiums I added in came from the calculators you linked above.  I'm confused a bit by what you are questioning.

[nmoira]

The calculator I used last night (not one of the three you linked above) provided a premium for our state and county. The premiums I added in came from the calculators you linked above.  I'm confused a bit by what you are questioning.

 

I'm only talking about the ones *I* linked to estimate premiums after subsidy. Sorry for the confusion. :)

[LMV]

I'm only talking about the ones *I* linked to estimate premiums after subsidy. Sorry for the confusion. :)

Yes I used your three calculators and got three very different answers.  That was my point in saying that they provided vastly different results for our family.  

 

At this point it probably makes sense to use the actual exchange calculators which are state and, at least in our state, county specific.

[nmoira]

Yes I used your three calculators and got three very different answers.  That was my point in saying that they provided vastly different results for our family.  

 

At this point it probably makes sense to use the actual exchange calculators which are state and, at least in our state, county specific.

 

Absolutely, but I was posting approximate figures only in response to the idea that a young person forgoing insurance to save a couple hundred a month in premiums, nothing more. The highest estimate, the one I quoted was $85 a month for Silver.

[LMV]

Absolutely, but I was posting approximate figures only in response to the idea that a young person forgoing insurance to save a couple hundred a month in premiums, nothing more. The highest estimate, the one I quoted was $85 a month for Silver.

Ok…if Martha's hypothetical 22 year old single individual lived in our county and worked full time at slightly above minimum wage where they were not provided with insurance.  They would need to pay approximately $200/monthly [actual plans $165-254]for their share of the premium on a plan that has a $2,000 deductible.  If they hit the deductible they will then pay only 30% of the cost of their care.  Once they have paid $5,000 out of pocket then they will no longer be responsible for any coinsurance costs.  

[nmoira]

Ok…if Martha's hypothetical 22 year old single individual lived in our county and worked full time at slightly above minimum wage where they were not provided with insurance.  They would need to pay approximately $200/monthly [actual plans $165-254]for their share of the premium on a plan that has a $2,000 deductible.  If they hit the deductible they will then pay only 30% of the cost of their care.  Once they have paid $5,000 out of pocket then they will no longer be responsible for any coinsurance costs.  

 

I get similar premium range for our area (including all plans, even Gold... $129 to $261), but these are BEFORE subsidy.

[LizzyBee]

Yes I used your three calculators and got three very different answers.  That was my point in saying that they provided vastly different results for our family.  

 

At this point it probably makes sense to use the actual exchange calculators which are state and, at least in our state, county specific.

 

I haven't been able to get to the actual exchange calculators yet. I would love to see if the estimates I've gotten are accurate.  The websites I used did ask for state and county, so maybe they are reasonably accurate.

 

[LizzyBee]

Yikes.  I used to work emergency and med/surg and never saw that.  It's ridiculously difficult to get Workers comp to cover anything here in IL or with my Mom's injury in NC.  I was at work on the floor and my knee was injured (torn ligament in knee)in the presence of two nurses and a nursing supervisor.  They sent me down to the ER to get it x-rayed and looked at, then I was sent back up to work on crutches and told Worker's Comp wouldn't cover it and I had to get back to work.  It's crazy.  I was a single mom with 2 kids, so you know I could totally afford that bill.

 

Yep, everyone I know who managed to get a workers' comp settlement had to use an attorney and it took years.  My bil filed a claim after my sister died, and the hospital personnel lied their butts off at the hearing.

 

[LMV]

I get similar premium range for our area, but these are BEFORE subsidy.

Presuming our hypothetical [or really Martha's hypothetical] individual is purchasing an individual plan the costs I quoted are after subsidy.  [i referred to to it as their "share" of the premium for that reason.]  Now if the hypothetical individual has a spouse, or a child, or both then they would be eligible for Medicaid in our state because we are one of the twenty states which opted to expand Medicaid.  In states that don't expand Medicaid [or have some alternative access gap plan which in fairness a few states are working on and some plans sound like they may have promise] poor families may be too poor to qualify for subsidies and not in a position to purchase insurance at full cost through the exchanges.  This is a concern!

[nmoira]

Presuming our hypothetical [or really Martha's hypothetical] individual is purchasing an individual plan the costs I quoted are after subsidy.  [i referred to to it as their "share" of the premium for that reason.]

 

I was talking only about my quote estimates (I live in Portland, OR) as I can't see yours. :) The CoverOregon website clearly stated this was before financial assistance: "Based on the information you entered, the plans listed below should be available to you. The premium costs you see are only estimates and don't factor in any financial help you might get."

 

22yo, single, non-smoker, $20000 per year income.

 

 

 

Now if the hypothetical individual has a spouse, or a child, or both then they would be eligible for Medicaid in our state because we are one of the twenty states which opted to expand Medicaid.  In states that don't expand Medicaid [or have some alternative access gap plan which in fairness a few states are working on and some plans sound like they may have promise] poor families may be too poor to qualify for subsidies and not in a position to purchase insurance at full cost through the exchanges.  This is a concern!

 

 

It's absolutely a concern. 

[Mrs Mungo]

In states that don't expand Medicaid [or have some alternative access gap plan which in fairness a few states are working on and some plans sound like they may have promise] poor families may be too poor to qualify for subsidies and not in a position to purchase insurance at full cost through the exchanges. This is a concern!

Some states are working on a solution for that. Have you see Arkansas's plan, for example?

http://abcnews.go.com/health/t/blogEntry?id=20468200&ref=https%3A%2F%2Fwww.google.com%2F

[idnib]

What I don't understand is why the government is REQUIRING everyone to get medical insurance? For the most part, I've found that physicians actually prefer

out-of-pocket payments, even if on a low monthly payment plan, because it's just  less hassle. If we prefer to pay for our medical needs that way, why are we being 

forced to do something else?

 

Because of the provision that people cannot be rejected for pre-existing conditions. If you (general) want people to be covered regardless of pre-existing conditions, then everyone must buy in. Otherwise nobody would buy in until they were too ill to pay for themselves and the entire insured pool would only consist of ill people, which is not sustainable.

[Reflections]

First off, I haven't been able to see any actual numbers. Where are you finding these quotes?

 

Second, friends of my dds are making the same statements - that they'll forgo insurance and pay the penalty. They are, for the most part, young people she works with. They aren't making $20,000; more like $12,000 or so. (Don't ask me how they live? Share an apt w/several others) Anyway, what I'm hearing is that their income is low enough that they won't get a subsidy and instead need to apply for Medicaid. However, my state did not expand Medicaid coverage, so basically you need to be a pregnant female to qualify for it. If what I'm hearing from them is correct, they are falling through the cracks, and yes, the penalty this year would be far, far cheaper.

 

I don't know for sure about any of this. In fact, I don't even know what it would cost me to get ins. on the exchange for the girls and me because I can't get past the damned application. Grrrr......

 

I'm glad you brought this up.  I've seen that some people are too poor to get health insurance through the ACA - and with their states not expanding medicaid, they can't get on there either. So then what??

 

Another loophole, if my dh's employer offers any kind of insurance, including an insurance policy that has us as a family of 5 paying $12,000 a year plus deductibles of $3000/$6000 - we can't use the exchange or qualify for a subsidy.   So then two questions:  would it be better for us to not have insurance at all - potentially one accident like we had this year could cost us $21,000 in medical expenses - almost half of my dh's salary - and so, should the company go ahead and not provide insurance and pay the penalty which would then be cheaper for the company and better for the employee because the employee could now get insurance through the exchange and qualify for the subsidy???

 

I remember this being a hotly debated point about 6 months ago here on this forum.

[poppy]

States require auto insurance to protect people or property you may injure while driving.  Mortgage companies require homeowner's insurance in order to protect their investment.

 

Neither auto insurance nor homeowner's insurance are required if you don't drive or own a house.  This is the only thing I can think of that you are required to buy simply through the act of being alive.

 

 

You drive a car, you get auto insurance. You own a home, you get homeowners insurance. You use the healthcare system, you get health insurance. I don't see what is so dramatically different.

I guess you could say that auto and home insurance is there to protect others who might be injured with your negligence.  But  failure to be properly medically insured does "injure" others in the sense that your costs are passed onto insurance holders. 

[poppy]

Article about the millions of people left uninsured because their state leadership opted to refuse to take part in the program that would help them, a program that is free to the state until 2016 and then covered 90% afterwards. Shameful.

 

 

[redsquirrel]

I know people with master's degrees working at low income, no-benefit jobs because that's all they can find in this economy. I am so tired of people saying that if people want better salaries and health insurance, they should get an education and a good job.  It's a kick in the teeth to people who are doing the best they can.

 

I am so thankful for my job and insurance, and yes, I worked hard to get where I am, but a lot of people work hard and can't seem to catch a break.

 

 

You know what I am looking forward to?  All those young people, in their 20s and 30s, spreading their wings and taking chances. I am So Much looking forward to the entrepreneurship that is going to take place. Just think of all those young people, who are freed from the burden of having to settle for a lousy job just to have health insurance. Just think of all the people who will decide to start that business, take that chance on a start up, really work on that invention because they know that their families won't lose their health care.

 

I think it is going to be very exciting. I know so many people who have been working at jobs they truly hate only to keep health insurance for themselves and their kids. They want to go back to school or start a small family business.  Well, now they can. I know many women who want to be homeschooling moms, but they have the job with health insurance for the family so they can't quit.

 

It is going to take some time, but I think for my kids' generation, there is going to be a lot of possibity.

 

[jillian]

You know I've got a daughter right now who takes medication that is $1500 a fill and we fill twice a month. With our insurance (thank God for tricare) it's only $44. We get out of the military next year and I am afraid of what is going to happen. I have a master's degree in marriage and family therapy. I can't find a job, and the jobs I do go to interviews for are covering only me with no option to cover family. I'm afraid of the outcome next year when my husband discharges. I do not know what is going to happen but I certainly know we won't be able to just pay thousands of dollars a month. We desperately need to keep my daughter's specialist (the only one in several surrounding states) that we see 3-4 times a year.

[Tabrett]

Has anyone noticed the minute clinics that Walgreens, CVS, Wal-mart, Target, Kroger+ more are setting up? Google it, it is quite interesting how many big box store are going to provide walk clinics.

 

I think this is what the ACA is wanting to take over regular 'sick' doctor visits. Then you would only see a doctor for speciality care. The minute clinics charge about $90 a vist and you are seen by a Doctors assistant or a nurse practitioner. I'm in NC and these clinics are popping up.

 

Here is an article about SC Medicaid being accepted at the clinics:

 

http://www.postandcourier.com/article/20120806/PC16/120809466/1005/store-clinics-to-see-medicaid-patients-move-intends-to-keep-minor-issues-out-of-er

 

Here is a list of what you can be seen for at the CVS minute clinic:

 

http://www.minuteclinic.com/services/minorillness/

 

Honestly, I think, after people discover these clinics, they aren't going to go to a doctor unless it is a true ER emergence or they have a special need.

 

This type of care will prevent people from using the ER for minor sickness. It will be convenient for people to get to the nearest CVS or Wal-mart or where ever. It will be a one-stop-shop for your sick-visit and your meds. It is a win win situation for these big box stores. All they have to do is hire a DA or a NP. They will be no doctor trying to pay rent, the store is guaranteed that the patient buys thier med form them and probably the patient will buy something while waiting on their meds to be filled. How convenient!

 

I may be a tin foil hat wearer, but I truly believe this is what the government is wanting to see happen. I don't think the government wants to tell people this is what they want, but they want people to discover the clinics themselves and think it was their idea for them to go there for care! If it is the people's idea, they will be happy. Problem solved!

 

This would make regular sick care affordable. Unfortunatly, this is bad news for general practitioners.... maybe.......or maybe people who have good insurance will keep seeing their regular doctor and low income people will have care too.

[Murphy101]

We don't have those minute clinics here. In fact, the cheap/free/low income clinics are very few and very far between and very difficult to get into. You could wait all day, literally, and not get in.

 

I'm actually very very pro universal healthcare. If this were universal healthcare, I'd be all over it jumping up and down thrilled excited about it.

 

But it's not. Insurance is the problem. Not the answer. Until we do away with insurance AND dramatically overhaul the nightmare that Medicaid/Medicare is, I don't believe for a second this will help poor people.

 

To people saying, oh if they can't afford insurance then they will qualify for Medicaid.

 

You need to know that is NOT a good thing. Medicaid is awful. Better than nothing? Sometimes it is. Sometimes it turns out to be nothing.

 

Case in point..

 

My son had a really awful planters wart on his foot. A fairly common non emergency thing to be sure. Until it went untreated for months because I could not get him in to a dermatologist to get it treated. But that point it was oozing green puss and was excruciatingly painful to walk on. Walking is very much a requirement of his daily life and his job.

 

I was in a waitlist for 3 MONTHS to get into either of the two drs in network on state insurance for kids. Finally I felt we just couldn't wait any longer. For crying out loud the kid needed pain killers in order to walk!

 

I called TWELVE doctors and not one of them were taking Medicaid or new patients and ALL of them said they'd have to waitlist us until February. I finally found one that would let us pay cash up front and could get us in the next day. $240 flat for the visit, the freeze treatment, and what I refer to as "The melon baller cut" to scoop the planter and infected tissue out (no injected painkiller, no local anesthetic) and follow up appointment.

 

Now, we aren't made of money. $240 came out of our grocery budget.

 

But that was a marble sized wound in my son's foot causing him daily pain. I shudder to think how bad it would have been if I waited until *maybe* a schedule opening in February.

 

I could list many other examples of Medicaid/Medicare not meeting the needs of those who need it.

 

So when I hear people say, "oh they will qualify for Medicaid/Medicare" or claim either is an example of limited universal healthcare - it leaves me really wondering how much they have to deal it personally. Because I don't know anyone that does who has such an optimist perspective of it. Maybe it's just awesome applesauce better in other states, but then again, I have family in other states who claim to wish they had it as good as Oklahoma. Which scares the bejezus out of me for them.

[QueenCat]

I'm glad you brought this up.  I've seen that some people are too poor to get health insurance through the ACA - and with their states not expanding medicaid, they can't get on there either. So then what??

 

Another loophole, if my dh's employer offers any kind of insurance, including an insurance policy that has us as a family of 5 paying $12,000 a year plus deductibles of $3000/$6000 - we can't use the exchange or qualify for a subsidy.   So then two questions:  would it be better for us to not have insurance at all - potentially one accident like we had this year could cost us $21,000 in medical expenses - almost half of my dh's salary - and so, should the company go ahead and not provide insurance and pay the penalty which would then be cheaper for the company and better for the employee because the employee could now get insurance through the exchange and qualify for the subsidy???

 

I remember this being a hotly debated point about 6 months ago here on this forum.

 

If your dh's employer's plan costs more than 9% of his salary than you are eligible for the exchange. Whether or not you'd get subsidies depends on your income. Incomes into the 80,000 range can qualify for some subsidies but not 100%.

[nmoira]

If your dh's employer's plan costs more than 9% of his salary than you are eligible for the exchange. Whether or not you'd get subsidies depends on your income. Incomes into the 80,000 range can qualify for some subsidies but not 100%.

 

It's only the component for her DH's own insurance that's counted for determining this though, not the premiums for the whole family. This is something that needs to be fixed.

[NicAnn]

Martha- that has been my experience with Medicaid. I once spent an entire work day trying to find a doctor to accept Medicaid. We ended up driving away from our large city to a rural town two hours away for an appointment. But I had to have a referral from a primary dr to see the specialist for the kids. So, we did what we had to.

[NicksMama-Zack's Mama Too]

Quote from Martha's last post:

 

"To people saying, oh if they can't afford insurance then they will qualify for Medicaid.

You need to know that is NOT a good thing. Medicaid is awful. Better than nothing? Sometimes it is. Sometimes it turns out to be nothing.

Case in point..

My son had a really awful planters wart on his foot. A fairly common non emergency thing to be sure. Until it went untreated for months because I could not get him in to a dermatologist to get it treated. But that point it was oozing green puss and was excruciatingly painful to walk on. Walking is very much a requirement of his daily life and his job.

I was in a waitlist for 3 MONTHS to get into either of the two drs in network on state insurance for kids. Finally I felt we just couldn't wait any longer. For crying out loud the kid needed pain killers in order to walk!

I called TWELVE doctors and not one of them were taking Medicaid or new patients and ALL of them said they'd have to waitlist us until February. I finally found one that would let us pay cash up front and could get us in the next day. $240 flat for the visit, the freeze treatment, and what I refer to as "The melon baller cut" to scoop the planter and infected tissue out (no injected painkiller, no local anesthetic) and follow up appointment.

Now, we aren't made of money. $240 came out of our grocery budget.

But that was a marble sized wound in my son's foot causing him daily pain. I shudder to think how bad it would have been if I waited until *maybe* a schedule opening in February.

I could list many other examples of Medicaid/Medicare not meeting the needs of those who need it.

So when I hear people say, "oh they will qualify for Medicaid/Medicare" or claim either is an example of limited universal healthcare - it leaves me really wondering how much they have to deal it personally. Because I don't know anyone that does who has such an optimist perspective of it. Maybe it's just awesome applesauce better in other states, but then again, I have family in other states who claim to wish they had it as good as Oklahoma. Which scares the bejezus out of me for them.

----------------------------------------------------------

 

My mother has Medicare and I've seen how little her doctor's are reimbursed, sometime as little as 15-20%.  It surprises me that doctors accept it at all.  I guess they make up the income in charging insured people much more.  

[Reflections]

If your dh's employer's plan costs more than 9% of his salary than you are eligible for the exchange. Whether or not you'd get subsidies depends on your income. Incomes into the 80,000 range can qualify for some subsidies but not 100%.

 

First, OOOOooooOOOOh, good to know! Thanks! :)  We are worried what is in the future in regards to our health insurance and this helps if we need to explore our options.

 

Second, this isn't our current insurance, but it was the insurance offered to us with a a job offer.  We turned it down - we were looking for a pay bump not a decrease.

[QueenCat]

It's 9.5% of the pretax household income, and it is just for the employee's coverage. The spouse and family are additional.

 

Thanks for correcting my .5% mistake.........

[LizzyBee]

I'm glad you brought this up.  I've seen that some people are too poor to get health insurance through the ACA - and with their states not expanding medicaid, they can't get on there either. So then what??

 

Another loophole, if my dh's employer offers any kind of insurance, including an insurance policy that has us as a family of 5 paying $12,000 a year plus deductibles of $3000/$6000 - we can't use the exchange or qualify for a subsidy.   So then two questions:  would it be better for us to not have insurance at all - potentially one accident like we had this year could cost us $21,000 in medical expenses - almost half of my dh's salary - and so, should the company go ahead and not provide insurance and pay the penalty which would then be cheaper for the company and better for the employee because the employee could now get insurance through the exchange and qualify for the subsidy???

 

I remember this being a hotly debated point about 6 months ago here on this forum.

 

I think a better solution would be for Congress to clarify that 1) "access to employer based insurance" means that the employer pays or subsidizes the premiums; and determination of access is applied separately to the employee and the employee's family members; and/or 2) Premiums paid as a percentage of household income is calculated using total premiums paid by the employee for himself and family members rather than employee-only coverage.

 

The law is currently ambiguous on those points, and the IRS did not interpret them in favor of taxpayers. :glare:

[Melinda in VT]

I agree - a family policy costs the same regardless of the number of children, so until the youngest reaches adulthood, there is no extra cost to have an adult child on the policy. 

 

This is not necessarily true. We are insured through my employer, and I pay a extra charge for each kid.

 

[LizzyBee]

Has anyone noticed the minute clinics that Walgreens, CVS, Wal-mart, Target, Kroger+ more are setting up? Google it, it is quite interesting how many big box store are going to provide walk clinics.

 

I think this is what the ACA is wanting to take over regular 'sick' doctor visits. Then you would only see a doctor for speciality care. The minute clinics charge about $90 a vist and you are seen by a Doctors assistant or a nurse practitioner. I'm in NC and these clinics are popping up.

 

Here is an article about SC Medicaid being accepted at the clinics:

 

http://www.postandcourier.com/article/20120806/PC16/120809466/1005/store-clinics-to-see-medicaid-patients-move-intends-to-keep-minor-issues-out-of-er

 

Here is a list of what you can be seen for at the CVS minute clinic:

 

http://www.minuteclinic.com/services/minorillness/

 

Honestly, I think, after people discover these clinics, they aren't going to go to a doctor unless it is a true ER emergence or they have a special need.

 

This type of care will prevent people from using the ER for minor sickness. It will be convenient for people to get to the nearest CVS or Wal-mart or where ever. It will be a one-stop-shop for your sick-visit and your meds. It is a win win situation for these big box stores. All they have to do is hire a DA or a NP. They will be no doctor trying to pay rent, the store is guaranteed that the patient buys thier med form them and probably the patient will buy something while waiting on their meds to be filled. How convenient!

 

I may be a tin foil hat wearer, but I truly believe this is what the government is wanting to see happen. I don't think the government wants to tell people this is what they want, but they want people to discover the clinics themselves and think it was their idea for them to go there for care! If it is the people's idea, they will be happy. Problem solved!

 

This would make regular sick care affordable. Unfortunatly, this is bad news for general practitioners.... maybe.......or maybe people who have good insurance will keep seeing their regular doctor and low income people will have care too.

 

I went to one of those clinics when I couldn't get a same-day appt to see my regular doctor.  I am not a fan. I would not in a million years give up my regular doctor for an impersonal cattle herding clinic. 

 

The fee was no less than if I'd gone to my family doctor, so it wasn't any more affordable. 

 

[LizzyBee]

This is not necessarily true. We are insured through my employer, and I pay a extra charge for each kid.

 

 

Maybe it varies by state.  In the states I've lived in and the various insurance providers we've had, the options for employer based policies were always employee only, employee plus one child, or family.

 

ETA: Oops, I left off the fourth option, employee plus spouse.

[Murphy101]

Maybe it varies by state. In the states I've lived in and the various insurance providers we've had, the options for employer based policies were always employee only, employee plus one child, or family.

Ours was always:

 

Employee only

Employee + partner

Employee &/or partner + 1 kid

Either of the above plus 2-3 kids

Either of the above plus 4+ kids

[Renee in NC]

So when I hear people say, "oh they will qualify for Medicaid/Medicare" or claim either is an example of limited universal healthcare - it leaves me really wondering how much they have to deal it personally. Because I don't know anyone that does who has such an optimist perspective of it. Maybe it's just awesome applesauce better in other states, but then again, I have family in other states who claim to wish they had it as good as Oklahoma. Which scares the bejezus out of me for them.

 

Medicaid is great here in NC - no problems using it.  There used to be a problem with dental care, but now we have a great dentist.

 

In FL?  It was horrible.  We basically had no coverage for anything other than prescriptions, pretty much as you mentioned elsewhere in this thread.

[Murphy101]

I went to one of those clinics when I couldn't get a same-day appt to see my regular doctor. I am not a fan. I would not in a million years give up my regular doctor for an impersonal cattle herding clinic.

 

The fee was no less than if I'd gone to my family doctor, so it wasn't any more affordable.

 

And this still does not address making genuine health care more affordable.

 

The only people I know who use a dr or ER for minor sickness, do so bc they have to. For example, their boss won't let them take a sick day without a dr note of some kind.

 

They might be genuinely sick and know for a fact the dr can't do a dang thing to treat a viral flu-like illness, but they also know if they miss more than 2 days in a row at work - they will be written up or fired. Even with a dr note sometimes. Many of them go in specificly asking for some symptom relief so they can avoid losing their job by going in medicated. I cannot count how often people I know have done that. We all know the best "treatment" is to just sleep it off between bowls of soup for 3-4 days. But that's is a luxury they can't afford. Many parents bring their kids in for the same reason. No school = no daycare = no pay missing work. They go to the ER bc it's free. Otherwise they'd just lose their job. And even so, many will still lose their job anyways.

[QueenCat]

Sorry to confuse you.  It's not the 0.5% that is significant, it is that the price for the spouse and the children will raise expenses significantly, should the employer choose to offer coverage for them. I am hearing that the expectation is about $20k in premiums plus out of pocket per year for a family.  It's no wonder that the unions have refused to participate..that would be a huge decrease in the take home pay compared to the current plans.

 

It is currently financially better for me to take a low income job with insurance, than to go thru the spousal plan of the employer. I know several other ladies in the same situation.

 

I wasn't confused.................. Nothing I saw on the exchange sites showed premiums at that level. Nor have I heard of group insurance premiums like that.........I'm also not sure what unions have to do with it. They can still negotiate plans for their members. The plans just need to be in compliance with the ACA.

[SwallowTail]

Thanks for correcting my .5% mistake.........

 Not sure if this was already clarified, but actually, the mistake in your post is that the 9.5% applies only to the premiums for the employee/individual coverage, which is oftentimes quite low.  The amount charged for family coverage is not being held to any limit, and even if it were 50% of your income, as long as the price for the individual coverage (employee only) is less than the 9.5% threshhold, then your family is inelegible for subsidies.  However, in the event it were cheaper somehow, I believe they can still purchase plans through the exhanges.

 

This is called the family glitch, is well-documented, and was apparently deliberate and not an inadvertent miscalculation on anyone's part.

[SwallowTail]

Sorry to confuse you.  It's not the 0.5% that is significant, it is that the price for the spouse and the children will raise expenses significantly, should the employer choose to offer coverage for them. I am hearing that the expectation is about $20k in premiums plus out of pocket per year for a family.  It's no wonder that the unions have refused to participate..that would be a huge decrease in the take home pay compared to the current plans.

 

It is currently financially better for me to take a low income job with insurance, than to go thru the spousal plan of the employer. I know several other ladies in the same situation.

 

We are about in that position as well, except I wouldn't have to take a low-income job due to my credentials, but we want me home so I can homeschool our child.  I will probably end up without insurance next year. (and have chronic untreated medical problems)

[QueenCat]

 Not sure if this was already clarified, but actually, the mistake in your post is that the 9.5% applies only to the premiums for the employee/individual coverage, which is oftentimes quite low.  The amount charged for family coverage is not being held to any limit, and even if it were 50% of your income, as long as the price for the individual coverage (employee only) is less than the 9.5% threshhold, then your family is inelegible for subsidies.  However, in the event it were cheaper somehow, I believe they can still purchase plans through the exhanges.

 

This is called the family glitch, is well-documented, and was apparently deliberate and not an inadvertent miscalculation on anyone's part.

 

Actually, I never indicated what the percentage applied to........... the only "mistake" in my post was not adding the .5 to my number (I did actually know it was 9.5 but was typing quickly and missed it). As to the rest of it, we will see what actually with the full implementation and the tweaks to the rules/regulations that we know will occur (as they do in all massive legislation like this).

[mytwomonkeys]

We'll I'm pretty bummed. I have been trying to get through at healthcare.gov and finally was able to see the plans offered for my family. The cheapest plan for us is a monthly premium of $200, & the deductible is $12,500. I know that is way better than what some will be charged. For us though, it is just catastrophic insurance and is of no benefit in the day to day things. The best plan is $600 and not feasible for us to afford. It says the government is paying quite a nice tax credit for us, but our previous catastrophic insurance was similar to this plan and only $300 at ehealthinsurance, so it doesn't seem like the affordability is vast in comparison (regardless of the credit). We are at the very cusp of making too much to be eligible for state insurance for the kids (i.e. Kid Care for moderate income families). It really stinks :(

[QueenCat]

We'll I'm pretty bummed. I have been trying to get through at healthcare.gov and finally was able to see the plans offered for my family. The cheapest plan for us is a monthly premium of $200, & the deductible is $12,500. I know that is way better than what some will be charged. For us though, it is just catastrophic insurance and is of no benefit in the day to day things. The best plan is $600 and not feasible for us to afford. It says the government is paying quite a nice tax credit for us, but our previous catastrophic insurance was similar to this plan and only $300 at ehealthinsurance, so it doesn't seem like the affordability is vast in comparison. We are at the very cusp of making too much to be eligible for state insurance for the kids (i.e. Kid care). It really stinks :(

 

From what I researched, the $12,500 is not just a deductible but TOTAL amount possible "out of pocket". Something relatively major would likely need to happen to reach that. And many things, like most preventive care, are covered at 100%, and aren't part of the "out of pocket". You might want to double check that; there are supposed to be Navigators to help with these questions.