Really? Who didn't see THIS coming?

[TranquilMind]

Obamacare legislation is a mess and people are finally starting to see that it is not working and will not work.  On home page, but not a very detailed write up.  Of course, this is all a set-up for single payer anyway. 

 

http://www.msn.com/en-us/money/markets/the-thrill-is-gone-for-obamacare-as-health-care-approval-fades/ar-BBnjijs?li=BBnbfcL&ocid=OIE9HP

 

 

From article:  "The administration’s Obamacare enrollment projections for the coming year are down, the projected cost of premiums and out of pocket costs are up, nearly half of the insurance co-ops associated with the program are going out of business, and UnitedHealth Group, the nation’s largest health insurer, said it may withdraw from the government marketplaces in 2017."

 

 

This was completely foreseeable, and many warnings were issued. 

 

 

[Carol in Cal.]

It's a shame.  

[Word Nerd]

I can also see a locked thread coming.

[applethyme]

:lurk5:

[Carol in Cal.]

This is such a complex problem.

 

We really did have quite a mess before, with great difficulty in getting insurance for people with preexisting conditions.  That had to be fixed--it was flat out inhuman.

 

But the solution doesn't work economically, IMO.  Insurers can't really tell how much to charge because now they have to take everyone, so they have a good excuse to raise rates a great deal.  Employers who have historically provided excellent medical insurance are under economic pressure to REDUCE coverage, which from a policy standpoint is crazy but economically would help to pay for everyone who doesn't have such an employer, but if, and only if, the employers continue to provide excellent coverage AND pay those hefty surcharges to be able to do so.

 

People who opted out before face higher fines this year.  I think (not sure about this) that the government subsidies drop this year.  The long term care part was quietly set aside before they even tried it, as completely unviable economically.  

 

There is quite a bit of evidence that part time employment is up compared to full time, and this correlates perfectly with the requirement to provide health care to full time workers.  

 

Anecdotes:  I know people who are paying more for their insurance than for their mortgage--triple what they paid before the ACA, and for worse coverage.  I know someone whose husband's employer stopped covering the family, just him, so she can no longer buy into the employer plan.  But they can't afford individual coverage for her and she can't get a subsidy because he has employer provided insurance, even though it doesn't cover her.  

 

I'm truly very glad that now everyone can get coverage in some fashion, but the cost issues and the loss of marketplace offerings have been so severe that I would have to say that generally things are worse than before, and will get even worse before they get better.

 

I wish that they had just extended the Medicare age down to 55 (covering most of the difficult late unemployment health care problems), and set up a special pool for the uninsurable.  I think that would have been cheaper and more effective than this.

[Liz CA]

Someone - probably the next President will have to deal with the fall out from that mess. I am wondering if we/they will have to revamp the entire system to bring something workable out of the ashes.

 

Carol brings up a lot of the issues. I do not think, however, that everyone can get insurance because now there are also people who cannot afford insurance - they are just a different demographic than before. Those are the ones like your friend who cannot be insured with her dh anymore and those who would be paying as much as a mortgage - I do not consider this "affordable insurance for everyone."

Edited November 22, 2015 by Liz CA

[Guest]

Honestly, the problem is so complex, there is no quick solution. This will take decades to fix (and I'm happy with the ACA).

[TranquilMind]

I can also see a locked thread coming.

Really?  It violates some term of service to express that a current occurrence was completely foreseeable?

 

Wow.  Whatever. 

 

I thought we did discuss current events here. 

[Guest]

Really? It violates some term of service to express that a current occurrence was completely foreseeable?

 

Wow. Whatever.

 

I thought we did discuss current events here.

You've been here long enough to know this is political.

[TranquilMind]

Someone - probably the next President will have to deal with the fall out from that mess. I am wondering if we/they will have to revamp the entire system to bring something workable out of the ashes.

 

Carol brings up a lot of the issues. I do not think, however, that everyone can get insurance because now there are also people who cannot afford insurance - they are just a different demographic than before. Those are the ones like your friend who cannot be insured with her dh anymore and those who would be paying as much as a mortgage - I do not consider this "affordable insurance for everyone."

Right.  That's the entire joke of it.  It is not "affordable" at all, even if you can get it.

 

I just paid an unexpected several thousand dollars for something.  Good thing I know our insurance is crap and was able to manage it, or well...who knows what would have happened.

 

I know everybody can't manage to cough up several thousand dollars on the spot, no matter how well they handle money.  This has to change. 

 

In the old days (like just a decade ago) EVERYTHING was covered when my parent had a major surgery and hospitalization (I now know we should have declined, but hindsight is 20/20).  I think I ended up paying about a grand total, after several months, for a few smaller bills that rolled in. 

Today, that would have bankrupted her or eliminated any equity she had in her lifelong home, as the hospital would have put a lien on it.  Something is very wrong with this picture. 

[Liz CA]

It does not have to end up political. Insurance is not a right or left wing issue as long as we can keep names and parties out of the discussion.

[Carol in Cal.]

I think, for starters, that congress should be forced into the same array of plan choices that the general public is.

 

And I agree, it's not affordable for many people at this point.  Nor is it realistic to expect that to improve, unless the insurers are showing huge profits and can be pressed to back down their rates.  But with so many leaving the market places entirely, we are approaching a crisis in many areas, and that militates against pressing  on their rates too much.  It is a full metal mess.

[TranquilMind]

It does not have to end up political. Insurance is not a right or left wing issue as long as we can keep names and parties out of the discussion.

Right.

 

Insurance is an equal opportunity pain.  :)

[TranquilMind]

I think, for starters, that congress should be forced into the same array of plan choices that the general public is.

 

And I agree, it's not affordable for many people at this point.  Nor is it realistic to expect that to improve, unless the insurers are showing huge profits and can be pressed to back down their rates.  But with so many leaving the market places entirely, we are approaching a crisis in many areas, and that militates against pressing  on their rates too much.  It is a full metal mess.

THIS, THIS, THIS (the bolded). 

 

I think we need to get rid of insurance entirely. What a racket. 

[Bluegoat]

It's not a set up for universal insurance, but if it were, that would be a good thing.  It works, and what's more most people in the US want it.

 

[ChocolateReignRemix]

Obamacare legislation is a mess and people are finally starting to see that it is not working and will not work.  On home page, but not a very detailed write up.  Of course, this is all a set-up for single payer anyway.

 

Oh I hope so!

 

[Butter]

I think, for starters, that congress should be forced into the same array of plan choices that the general public is.

 

They DO.  The oft repeated thing about Congress being exempt is, in fact, a myth.  AHA didn't require everyone to buy on the exchanges.  If your company provides insurance you can get it that way.  Members of Congress, being federal employees, were provided insurance - the same options my husband, as a federal employee gets in fact - and so they would, according to AHA be able to keep doing that.  But people weren't okay with that and claimed it meant they were exempt from ObamaCare so members of Congress ended up having to buy from the exchanges.  The Congress must use exchanges amendment actually made it so an employer (federal government) was forced to refuse to provide insurance for some of their employees (members of Congress).  And yet the "Congress is exempt" myth still lives on.

http://obamacarefacts.com/congress-obamacare/  

http://www.factcheck.org/2013/05/congress-and-an-exemption-from-obamacare/   

http://politicalticker.blogs.cnn.com/2013/09/25/fact-check-congress-staff-are-exempt-from-obamacare/

 

Edited to try to fix the links. But it didn't work. I can't get the second two to link properly. You'll have to copy and paste if you want to go there.

Edited November 22, 2015 by Butter

[Aelwydd]

It's that time of year again...when medical conglomerates and insurers get that rapey look in their eyes. 

 

Yes...it's the US Healthcare system's annual cervical check (a.k.a., the congressional review of How Freakin' Expensive Will This Get).

 

I can't tell you what it will take to clean up the whole mess.  :sleep:

[Lady Florida.]

  Of course, this is all a set-up for single payer anyway. 

 

 

 

Oh, that would be fantastic, but I'm afraid it's just wishful thinking at this point. Single payer would be so much better than what we had before the ACA and what we have in some states under the ACA. 

 

I'm a big supporter of single payer.

Edited November 23, 2015 by Lady Florida

[Audrey]

I can also see a locked thread coming.

 

Should be deleted.  It's absolutely partisan politics.

[Carrie12345]

 

 

Anecdotes:  I know people who are paying more for their insurance than for their mortgage--triple what they paid before the ACA, and for worse coverage.  I know someone whose husband's employer stopped covering the family, just him, so she can no longer buy into the employer plan.  But they can't afford individual coverage for her and she can't get a subsidy because he has employer provided insurance, even though it doesn't cover her.  

 

 

 

Perhaps another state issue, rather than federal?

We were offered a (very tiny) subsidy for me and the kids last year, even though dh's employer offers coverage for just him.

 

I get a very strong impression that many people blame ACA as a whole for the choices individual states/ins. companies have made.

[ChocolateReignRemix]

Perhaps another state issue, rather than federal?

We were offered a (very tiny) subsidy for me and the kids last year, even though dh's employer offers coverage for just him.

 

I get a very strong impression that many people blame ACA as a whole for the choices individual states/ins. companies have made.

You are correct.

 

People also tend to blame the ACA for all insurance changes that may occur, ignoring the rapid increase in premiums and deductibles that have been the norm for the past 20 years.

 

The ACA has a lot of problems (starting with still relying on providing care via a for profit private insurance model) but it is not responsible for all the issues we have the health insurance market.  Not even close.

 

[Mergath]

I think the ACA and the politicians who got it through did as much to reform healthcare as was possible, given the current political climate and hardcore partisan divisions of our government. There was never going to be a quick fix that gave everyone affordable, high-quality insurance, not when the gatekeepers of healthcare in this country are for-profit insurance companies.

 

Our options at this point seem to be to not let sick people have insurance, let sick people have insurance but charge everyone a fortune, or burn the current system to the ground and rebuild as a single-payer system. I'm keeping my fingers crossed for the third option. Sadly, I know a lot of people who thought the first option was just peachy because they have the good fortune to be healthy at the moment.

[FaithManor]

It's that time of year again...when medical conglomerates and insurers get that rapey look in their eyes. 

 

Yes...it's the US Healthcare system's annual cervical check (a.k.a., the congressional review of How Freakin' Expensive Will This Get).

 

I can't tell you what it will take to clean up the whole mess.  :sleep:

This is a perfect analogy!

 

My niece pays the fines. She doesn't make enough to have a roof over her head and buy from the exchange, and $1500.00 per year too much to get Medicaid.

 

We need something that works better than this. We need to take the insurance industry out of the driver's seat.

[SparklyUnicorn]

It's a shame really.  I would really like to see affordable care for everyone.  It's just going to be difficult to get to that point.  I was glad that finally a president managed to get something passed, but I do agree it is far from ideal. 

[ThisIsTheDay]

They DO. 

 

Thank you for posting this.  I didn't realize people still believed this to be true.

 

I work in the Medicaid system. I'll only say that I blame the ACA for a lot, including furthering the economic destruction of this country in ways that we can't even begin to imagine.  It is far less user-friendly (oh, not that Medicaid ever was easy to begin with), the costs associated with mandated changes are astronomical and do not improve the system or your coverage ONE bit.  Additionally, due to the MANDATED lack of checks that states are able to perform to verify coverage, yourour Federal tax dollars are being hemorrhaged away in astronomical amounts, and there is no chance it will EVER be recovered.

 

It's not partisan. It was a horrible law, and while you may think whatever you want about it, that doesn't change the facts of the law in total and the damage it will have on the U.S.

[SparklyUnicorn]

I think a big issue is that individual states were allowed to decide whether or not they wanted to expand medicaid.  So if you happen to live in one of those states you are forced to buy insurance you may not be able to afford.  Where I live they already had a lot of assistance in place, that was improved a bit with obamacare. 

[Luanne]

It's easy to see people who aren't bein effected by this. They are the ones who want this thread locked.

[Tanaqui]

It's easy to see people who aren't bein effected by this. They are the ones who want this thread locked.

 

Or maybe we just know it WILL be locked because certain parties are sitting around taking potshots at those they don't agree with rather than calmly and clearly stating their views and information. I won't name names, but only because you're hardly the only one engaging in this childish behavior.

[SparklyUnicorn]

*sigh*

 

 

[poppy]

Really?  It violates some term of service to express that a current occurrence was completely foreseeable?

 

Wow.  Whatever. 

 

I thought we did discuss current events here. 

 

First word of the first post was Obama!   Let's not pretend this is apolitical.

Edited November 22, 2015 by poppy

[Luanne]

It's about insurance.

[Liz CA]

So... what are some alternatives?

Going back to dealing directly with our doctors and hospitals and working out charges / paying on payment plans / choosing what type of care we want or can afford? How about hospitals / doctors not being able to turn anyone away? We all probably want care first (especially in emergencies) before someone scans our account balance for ability to pay.

 

What does it mean to take the insurance companies out of the driver's seat? I am all for it but what role - if any - should insurance carriers play?

 

I am truly asking for some kind of alternative model here because it is too difficult for me to imagine what scenario could actually work - or at least work better than what we've had in the last few years. I do not have the inside knowledge. I only know that the hair on the back of my head stands up when I hear the word "insurance."

Edited November 22, 2015 by Liz CA

[Joker]

My dh is involved with ACA for another very large insurance company (not United) and their enrollment is up for 2016. Not all are seeing dwindling numbers and talking of pulling out of the exchange.

[Slache]

So... what are some alternatives?

Going back to dealing directly with our doctors and hospitals and working out charges / paying on payment plans / choosing what type of care we want or can afford? How about hospitals / doctors not being able to turn anyone away? We all probably want care first (especially in emergencies) before someone scans our account balance for ability to pay.

 

What does it mean to take the insurance companies out of the driver's seat? I am all for it but what role - if any - should insurance carriers play?

 

I am truly asking for some kind of alternative model here because it is too difficult for me to imagine what scenario could actually work - or at least work better than what we've had in the last few years.

Allow state insurance to sell across state lines. When I was pregnant with John I was on Ohio state insurance. It was amazing and only costed tax payers $400 a month (thanks Ohio peeps!). I would rather pay $400 out of pocket for that than what I'm paying now.

[ChocolateReignRemix]

So... what are some alternatives?

Going back to dealing directly with our doctors and hospitals and working out charges / paying on payment plans / choosing what type of care we want or can afford? How about hospitals / doctors not being able to turn anyone away? We all probably want care first (especially in emergencies) before someone scans our account balance for ability to pay.

 

What does it mean to take the insurance companies out of the driver's seat? I am all for it but what role - if any - should insurance carriers play?

 

I am truly asking for some kind of alternative model here because it is too difficult for me to imagine what scenario could actually work - or at least work better than what we've had in the last few years. I do not have the inside knowledge. I only know that the hair on the back of my head stands up when I hear the word "insurance."

 

A phase in step would be to allow people to buy policies through Medicare at any age. 

[SparklyUnicorn]

So... what are some alternatives?

Going back to dealing directly with our doctors and hospitals and working out charges / paying on payment plans / choosing what type of care we want or can afford? How about hospitals / doctors not being able to turn anyone away? We all probably want care first (especially in emergencies) before someone scans our account balance for ability to pay.

 

What does it mean to take the insurance companies out of the driver's seat? I am all for it but what role - if any - should insurance carriers play?

 

I am truly asking for some kind of alternative model here because it is too difficult for me to imagine what scenario could actually work - or at least work better than what we've had in the last few years. I do not have the inside knowledge. I only know that the hair on the back of my head stands up when I hear the word "insurance."

 

I think a big issue is controlling costs in general. 

[poppy]

It's about insurance.

 

You know what?   I didn't even click the link before I replied.  Now that I have, I've learned that  the whole point of it was:  "Although Americans were more positive about the cost, quality and coverage of U.S. healthcare in the early years Obama’s first term, that optimism has faded to some degree. Americans’ ratings of healthcare coverage are not high, but remain higher than they were in George W. Bush’s second term."  So, the bottom line is, people are happier than they were 7-8 year ago.  Who didn't see THAT coming? 

[TammyS]

So... what are some alternatives?

Going back to dealing directly with our doctors and hospitals and working out charges / paying on payment plans / choosing what type of care we want or can afford? How about hospitals / doctors not being able to turn anyone away? We all probably want care first (especially in emergencies) before someone scans our account balance for ability to pay.

 

What does it mean to take the insurance companies out of the driver's seat? I am all for it but what role - if any - should insurance carriers play?

 

I am truly asking for some kind of alternative model here because it is too difficult for me to imagine what scenario could actually work - or at least work better than what we've had in the last few years. I do not have the inside knowledge. I only know that the hair on the back of my head stands up when I hear the word "insurance."

 

I'm not an expert on anything, so this is just my opinion.  I don't think insurance companies (or profit, for that matter) are evil.  They aren't even hugely profitable, as large businesses go (roughly 4% average profit margin).  We have to face the reality that if we ask a company to make much less than that, the company just isn't going to exist, because there are other ways to make money.  And it doesn't help to demonize them, either.

 

Another problem that I see in our current situation is that we have separated the PAYER and the CONSUMER.  When you do that, for sure you are going to get market distortions and an increase in consumption, and an increase in costs and price.  Here are two articles that show a little bit how this works: http://commonhealth.wbur.org/2012/05/consumers-health-costshttp://www.npr.org/2015/10/09/447098694/why-most-people-don-t-shop-around-for-medical-procedures.  The consumers of health care need to become once again the payers of their health care, or at least create a model where it pays for them to be cost conscience.  Right now we have a system, mostly, where people either don't know (and mostly don't care) what their medical consumption costs, or they can't afford insurance so they get nothing.

 

There are probably lots of ways to model this, high-deductible HSA plans is one (we have this currently, and I'm mostly ok with it, but can't help think that the $14K annual price tag is a bit much), ministry medical cost-share plans, old fashioned "major medical" plans that only cover very serious situations and you pay everything else out of pocket.  I'm sure there are other ways, but that's a start. 

 

I don't think that we will ever get this under control until consumers of medical care have significant skin in the game.

[K&Rs Mom]

So, the bottom line is, people are happier than they were 7-8 year ago. 

 

I'm not happier.  Our monthly premium has nearly doubled in 3 years, and less is covered than before.  I now have to consider whether something is really THAT serious before considering calling the doctor - even turned the car around deciding not to take dd to the ER because I could probably manage it with butterfly bandages instead of getting stitches.

 

I wish the name "Obamacare" would go away, so this could be discussed more rationally, without name calling.  It's not the work of one person, and that person being so polarizing doesn't help the discussion.

Edited November 22, 2015 by K&Rs Mom

[justasque]

It's easy to see people who aren't bein effected by this. They are the ones who want this thread locked.

 

If I remember correctly, you have a lot of experience with the health care system, right?  I'd be interested in your opinion.

If we repeal the ACA, what do you think we should put in its place?  

Should we lean towards "Medicaid/Medicare for everyone" (single-payer), or entirely self-pay, or something in between?

[Word Nerd]

It's easy to see people who aren't bein effected by this. They are the ones who want this thread locked.

Predicting that a political topic that has been heated in the past is likely to be so again is not the same as wanting it to be locked.

Edited November 22, 2015 by Word Nerd

[Audrey]

You know what?   I didn't even click the link before I replied.  Now that I have, I've learned that  the whole point of it was:  "Although Americans were more positive about the cost, quality and coverage of U.S. healthcare in the early years Obama’s first term, that optimism has faded to some degree. Americans’ ratings of healthcare coverage are not high, but remain higher than they were in George W. Bush’s second term."  So, the bottom line is, people are happier than they were 7-8 year ago.  Who didn't see THAT coming? 

 

Oh, don't go bringing your silly facts along for the ride now.  ;)   :lol:

[TammyS]

Here's an article about how consumerist patterns (that is, shopping around and looking for value in the services that you are paying for) in plastic surgery have kept prices down and innovation up for the last two decades: http://healthblog.ncpa.org/why-cant-the-market-for-medical-care-work-like-cosmetic-surgery/

[Mergath]

Here's an article about how consumerist patterns (that is, shopping around and looking for value in the services that you are paying for) in plastic surgery have kept prices down and innovation up for the last two decades: http://healthblog.ncpa.org/why-cant-the-market-for-medical-care-work-like-cosmetic-surgery/

 

A lot of times with healthcare though, you don't have time to shop around. If you're in a car accident, for example, and you're bleeding internally, you can't take a couple days to find the cheapest surgeon. Or if you wake up and your kid has a fever of 105 and abdominal pain, you aren't going to kick back and comparison shop on the internet. Also, when it's something serious, you're pretty much restricted to what's available locally. If my kid has a uti and is peeing blood or has a respiratory infection and is wheezing, I'm not going to make her ride in the car for two hours to get to a reasonably-priced doctor. With something like a tummy tuck, that's not an issue.

[Tsuga]

It's easy to see people who aren't bein effected by this. They are the ones who want this thread locked.

 

Everyone is affected by it.

 

The correlation is that people in liberal areas have received the benefits associated with the plan because their states allowed it; those who are in conservative areas are less likely to have had access to those benefits.

 

Liberal areas have more liberals; conservative areas have more conservatives.

 

My state absolutely has benefited more from the federal dollars coming our way for highway funds and other infrastructure spending because we took it even though we've been a net contributor for years.

 

Other states are not getting federal support because they rejected it.

 

So they're getting screwed. But they could, as far as I know, take the benefits to expand medicare at any time. They choose to allow insurance companies to screw people over.

 

The idea of mandatory health care without support for the poor was always a terrible one because it forced people to buy from an unregulated industry. I think most of us agree on that!

 

However, the degree to which there are no options for the poor and to which people are getting screwed up the yin-yang is different in different areas, mainly based on how well their state is covering those who were previously uninsured. In the case of my state, they already had a nonprofit insurance company LifeWise which had reasonable rates and a nonprofit mandate, and they expanded medicaid. Has it been perfect? No.

 

But things have gone better where people are getting the federal support they are entitled to to help offset changes in the market.

[TammyS]

A lot of times with healthcare though, you don't have time to shop around. If you're in a car accident, for example, and you're bleeding internally, you can't take a couple days to find the cheapest surgeon. Or if you wake up and your kid has a fever of 105 and abdominal pain, you aren't going to kick back and comparison shop on the internet. Also, when it's something serious, you're pretty much restricted to what's available locally. If my kid has a uti and is peeing blood or has a respiratory infection and is wheezing, I'm not going to make her ride in the car for two hours to get to a reasonably-priced doctor. With something like a tummy tuck, that's not an issue.

 

Actually, the article addressed that.  Only $1 in $20 is spent on emergency care.  In an emergency, of course you go to the most reasonable place (eta: I mean reasonable under the circumstances, not reasonable meaning "cheap").  But what about the other $19?

Edited November 23, 2015 by TammyS

[abba12]

I simply don't understand how the USA got this so very, very wrong. 

 

Many other countries manage to have state funded healthcare that works. I can't imagine having to worry about money while in hospital. With the exception of one private physiotherapist, I think I've paid no more than $1000 in medical expenses across my entire married life, and that's with me being legally blind and having mental health issues, my husband having a rare chronic condition, and us birthing three children. 

 

I just cannot understand the system, or how they have managed to break it so very badly over there. 

[ChocolateReignRemix]

I'm not happier.  Our monthly premium has nearly doubled in 3 years, and less is covered than before.  I now have to consider whether something is really THAT serious before considering calling the doctor - even turned the car around deciding not to take dd to the ER because I could probably manage it with butterfly bandages instead of getting stitches.

 

I wish the name "Obamacare" would go away, so this could be discussed more rationally, without name calling.  It's not the work of one person, and that person being so polarizing doesn't help the discussion.

 

Considering the average premium was increasing 20% annually prior to the ACA, why is your assumption that the ACA is the sole reason for your current increase?  And how does this play when others say they are now paying less for better coverage?

 

I am not saying you are wrong for being upset.  I think we can (and should) do much better than the ACA, but the typical reforms being suggested are generally insignificant in the grand scheme of rising costs or are just throwbacks to the status quo prior to the ACA.

Edited November 23, 2015 by ChocolateReignRemix

[Guest]

The fastest way to drive down costs is to abolish group rates and bargaining with medical services and require prices be published and paid. If everyone takes a hit, and certain groups aren't paying next to nothing, the cost for everyone should drop overall. Our state has wanted to implement an HSA style system for Medicaid dollars for a decade and was working to implement it until the current governor came into office - it was a brilliant way to take the stigma and limitations off patients (money could be spent whenever it was needed and not just certain providers) and also put a cap on spending to encourage wise choices in treatment and shopping around for better deals. They even wanted an appeal system in place for needs and treatment that exceeded the yearly allotment so those who were chronically or catastrophically ill could get the help they needed on an individual basis.

 

A solution like that - no group bargaining (which screws over everyone not in the group) and HSA accounts for those receiving assistance with their medical care would cut millions in waste on both sides of the equation and give the power of their care and choice in provider back to the consumer. It's my favorite alternative to single payer and doesn't drive providers out of business or cause care provider shortages and wait lists.

 

I really hope we can implement it here in Alaska or in another state and test the model out more thoroughly.