ACA reversal/change?

[redheadmom]

kewb, I haven't read past your reply yet, but have to give you  :grouphug: .  

 

You articulated my own fear.  I am farther along in treatment than your DH, and I'm in remission (technically, this stuff is never gone, and I have relapsed so many, many times over the years, I fear it with a deep, visceral, all-consuming fear, when I let it surface.  It takes one's breath away.).

 

I hope there will be an answer for us.

 

 

I am very concerned about repealing aca. Both dh and I have preexisting conditions. Mine, I can afford to pay out of pocket if necessary.

Dh will die. We won't be able to afford insurance. We won't be able to pay for his prescription meds. We won't be able to pay the specialists he needs to see. Yes, he will die and he will be in horrible pain while we wait for it to happen. He will be miserable to be around and it will take an additional toll on the family. Living with someone who has a chronic illness isn't difficult enough. No insurance will be adding insult to injury.

 

I am in the same position.  I have a very rare cancer with no cure.  Right now I have put off taking medicine because 1. It won't cure me; it's only for QOL.  2. Insurance will deny it and have to be appealed.  3. Right now I am holding my own so I don't want to create a $3k++ prescription bill every month. 

 

I stress constantly about bankrupting my family.  I am worried about the pre-existing conditions not being covered and not seeing my specialists or getting the labs and tests I need to know whats going on.   I sometimes feel guilty that I am going to run up insurance for everyone else.  It's not in my control but every medicine is expensive or just off clinical trials.  If I ever need a stem cell transplant, that is almost $1million dollars that someone is covering.  

 

It's just all so frustrating. 

[maize]

Huge hugs to those facing major medical issues :grouphug: :grouphug: :grouphug:

[Spryte]

I am in the same position. I have a very rare cancer with no cure. Right now I have put off taking medicine because 1. It won't cure me; it's only for QOL. 2. Insurance will deny it and have to be appealed. 3. Right now I am holding my own so I don't want to create a $3k++ prescription bill every month.

 

I stress constantly about bankrupting my family. I am worried about the pre-existing conditions not being covered and not seeing my specialists or getting the labs and tests I need to know whats going on. I sometimes feel guilty that I am going to run up insurance for everyone else. It's not in my control but every medicine is expensive or just off clinical trials. If I ever need a stem cell transplant, that is almost $1million dollars that someone is covering.

 

It's just all so frustrating.

Oh dear. ((Hugs)) for you, too.

 

I get it. DH and I started marriage with me having terribly expensive medical conditions. It's never stopped. At one point we used all the equity in our home to cover part of my treatment. It was $5K per month for a long time, and hefty monthly bills for 5 years. I still feel deep, horrible guilt. Seriously, if I were a horse, I'd have been put down long ago. :( We sold that house and every bit went to paying off those bills. $100K +. That didn't cover all my treatments but it covered what we'd put on the equity line. We have much more medical debt, still. It's impacted our ability to save for retirement, college, everything.

[kewb]

I am in the same position. I have a very rare cancer with no cure. Right now I have put off taking medicine because 1. It won't cure me; it's only for QOL. 2. Insurance will deny it and have to be appealed. 3. Right now I am holding my own so I don't want to create a $3k++ prescription bill every month.

 

I stress constantly about bankrupting my family. I am worried about the pre-existing conditions not being covered and not seeing my specialists or getting the labs and tests I need to know whats going on. I sometimes feel guilty that I am going to run up insurance for everyone else. It's not in my control but every medicine is expensive or just off clinical trials. If I ever need a stem cell transplant, that is almost $1million dollars that someone is covering.

 

It's just all so frustrating.

Hugs to you. I understand your feelings.

[Azalea]

I'm thinking of the Republicans actually manage to put together a decent healthcare plan...the Democrats are likely to fight it tooth and nail. Because that is how the game of politics is played; they will not want the opposing party to get credit for anything successful.

 

In my dreams, politicians would consistently have the good of the people at heart, and bipartisan cooperation would be the norm. That is a dream world though.

 

I can agree with you that politics is an ugly game and that the Democrats will likely do their best to obstruct the Republicans on many issues. But I'm not sure about this issue. I can see the Reps being able to get 60 votes to repeal ACA, because it has so many problems. They could do this to force Reps to actually have a replacement plan. Then the dems will be glad for their constituents if it works, or glad for their own election prospects if the reps fall on their faces. Enough voters will dislike whatever change is made that cynically I can see this working out well for the dems regardless of what the reps do.

 

Great big hugs to everyone who is scared and hurting, I am right there with you.

[maize]

I can agree with you that politics is an ugly game and that the Democrats will likely do their best to obstruct the Republicans on many issues. But I'm not sure about this issue. I can see the Reps being able to get 60 votes to repeal ACA, because it has so many problems. They could do this to force Reps to actually have a replacement plan. Then the dems will be glad for their constituents if it works, or glad for their own election prospects if the reps fall on their faces. Enough voters will dislike whatever change is made that cynically I can see this working out well for the dems regardless of what the reps do.

 

Great big hugs to everyone who is scared and hurting, I am right there with you.

You know, I hope you're right. We badly need positive progress in healthcare reform.

 

My perception in retrospect (I wasn't old enough at the time for analysis) was that Bill Clinton managed more bipartisan cooperation than the average president; I was hoping that would be true of Hillary.

 

Interestingly, I think there is a possibility of Trump pulling off some bipartisan stuff; he's not a typical Republican and certainly not ultra conservative.

 

He campaigned in an extremely divisive way, but I am not certain he will govern that way.

[KarenNC]

I haven't read all that's being said here, but everything I'm hearing about GOP intentions is "repeal and replace." I really doubt the intention is to leave a vacuum that would create an even bigger mess/crisis.

 

Unfortunately, I am afraid that they will repeal before taking the time to come up with a real plan of how to replace in order to gain favor with their constituencies so that we will still end up with a bigger mess that will take longer to sort out. If there had been any real details on a workable plan by the GOP (much less the president-elect) to replace it at any point since it was implemented, I haven't heard them.

[KarenNC]

Interestingly, I think there is a possibility of Trump pulling off some bipartisan stuff; he's not a typical Republican and certainly not ultra conservative.

 

He campaigned in an extremely divisive way, but I am not certain he will govern that way.

 

From your keyboard to the Gods' ears!

[ChocolateReignRemix]

I'm thinking of the Republicans actually manage to put together a decent healthcare plan...the Democrats are likely to fight it tooth and nail. Because that is how the game of politics is played; they will not want the opposing party to get credit for anything successful.

 

In my dreams, politicians would consistently have the good of the people at heart, and bipartisan cooperation would be the norm. That is a dream world though.

 

If the Rs put forth a healthcare the Ds can support (not holding my breath), the Ds will vote for it.  Healthcare reform is too crucial to their party base for them to be able to do otherwise.

 

That is assuming that the reforms offered are real and not just another expanded HSAs or insurance industry subsidy.

[maize]

From your keyboard to the Gods' ears!

Amen.

[maize]

If the Rs put forth a healthcare the Ds can support (not holding my breath), the Ds will vote for it. Healthcare reform is too crucial to their party base for them to be able to do otherwise.

 

That is assuming that the reforms offered are real and not just another expanded HSAs or insurance industry subsidy.

I certainly hope so.

 

If course, health care reform is important to every constituency except for the tiny minority of the wealthy.

 

Some folks are just more aware of the need than others.

[Lanny]

On the 6 P.M. ET news from the USA tonight (10 NOV 2016) there was a discussion, about what will be involved, when they try to fix/improve or replace ObamaCare. Within the almost 3000 pages of the legislation (which nobody in the U.S. Senate or House of Representatives read, before the legislation was passed into law) there is, woven into Obamacare, a lot of stuff that impacts funding for the Medicare and Medicaid entitlement programs. It will be VERY tricky, to try to fix/improve or replace ObamaCare, without adversely affecting Medicare and Medicaid, which are huge entitlement programs used by tens of millions of Americans each day.                           i

[KarenNC]

It will be interesting to see if part of it will be that the states which previously refused to expand Medicaid now find it a desirable option.

[frogger]

Yes, but the estimates all show that medicare for all would be significantly less than premiums.

I'm not sure how one would come up with numbers for this. Medicare doesn't pay the same prices as the private sector. In our state if you are going to be eligible for Medicare within a decade you simply can't find a doctor. They have their required number of Medicare patients and refuse to accept new patients because they lose money on them. I'm not sure if this loss is actual loss or just relative compared to private insurance or self pay individuals. That is why my Father can't find a doctor for his heart condition. Even though he has insurance and will pay cash they won't take him because then they would be stuck with him once he hits that magical age when Medicare kicks in.

 

Everyone is focused on insurance but really I think health care costs are the biggest factor. I just paid over $1000 for a needle, thread, and forty minutes of a doctor's time. That number makes no sense to me.

It will be VERY tricky, to try to fix/improve or replace ObamaCare, without adversely affecting Medicare and Medicaid, which are huge entitlement programs used by tens of millions of Americans each day.                          

 

Perhaps, instead of spending the last six years wasting time and money proposing and voting on 60 bills to repeal the ACA, knowing that they'd get veto'ed, some of this time and money could have been spent thinking about how to improve it, instead of political grandstanding.

[ktgrok]

When I read your reply, I got a thought. There are people here on WTM who participate in Faith based Health Care cooperatives. I am not sure what the correct term is, but they seem to be happier with what they pay/receive than people with "normal" medical insurance at this time. From what I understand, now, new people cannot join those cooperatives?

 

 

 

None of them cover people with chronic conditions, pre-existing ongoing conditions, etc. They are not an answer for the people scared they can't get coverage. 

[ktgrok]

I haven't read all that's being said here, but everything I'm hearing about GOP intentions is "repeal and replace." I really doubt the intention is to leave a vacuum that would create an even bigger mess/crisis.

He has said he wants to replace it with more HSA accounts and that's about it. 

[ktgrok]

I'm not sure how one would come up with numbers for this. Medicare doesn't pay the same prices as the private sector. In our state if you are going to be eligible for Medicare within a decade you simply can't find a doctor. They have their required number of Medicare patients and refuse to accept new patients because they lose money on them. I'm not sure if this loss is actual loss or just relative compared to private insurance or self pay individuals. That is why my Father can't find a doctor for his heart condition. Even though he has insurance and will pay cash they won't take him because then they would be stuck with him once he hits that magical age when Medicare kicks in.

 

 

 

But if the ONLY option was medicare, and everyone had it doctors would have to take it, or go out of business. 

[purplejackmama]

But if the ONLY option was medicare, and everyone had it doctors would have to take it, or go out of business.

I'm not convinced Medicare for all is the answer. My dad recently started using Medicare and his blood pressure medicine isn't covered. But it's not only not covered it's illegal for him to buy it with cash. This is crazy to me.

[ChocolateReignRemix]

I'm not convinced Medicare for all is the answer. My dad recently started using Medicare and his blood pressure medicine isn't covered. But it's not only not covered it's illegal for him to buy it with cash. This is crazy to me.

 

That is not true.  I am not sure who told him that but it is not even remotely true.

[purplejackmama]

That is not true. I am not sure who told him that but it is not even remotely true.

Dr. and Pharmacist. He now buys his RX from Canada. Are you saying my father or the medical professionals are lying?

[purplejackmama]

Well actually providers aren't allowed to provide non-covered services to Medicare beneficiaries even if the patient is self pay. I used to work for a provider that provided a service that was not covered by Medicare. Our Compliance officer said that we were prohibited from providing this service to Medicare enrollees even if they paid out of pocket and signed the Assignment of Benefits.

Thanks for the follow up.

[frogger]

That is not true. I am not sure who told him that but it is not even remotely true.

 

I guess all the docs who talk to my father are lying too.

[Happy2BaMom]

But if the ONLY option was medicare, and everyone had it doctors would have to take it, or go out of business. 

 

I hear what you are saying, but the reasons doctors won't accept Medicare is because Medicare doesn't pay enough to cover the costs (I'm not talking profit here) of seeing that patient. If you pay them enough to make it worthwhile, "premiums" (cost of funding) will jump tremendously.

 

I am really curious to see what is going to be proposed to replace Obamacare...because we have a very unhealthy population in the U.S. where many people require very expensive care. We subsidize low-nutrient, highly-sprayed monocrops which end up in processed foods, import many of our vegetables long distances, and then wonder why costly degenerative diseases are springing up in more and more people. Insurance companies and pharmaceutical companies make billions of dollars in profits, yet no one - not even the new Administration - will touch that, after all, corporate profits are the cornerstone of the "free market".

 

Until American people can get a grip on the fact that both political parties largely serve corporate interests over what is good for the common people, we will continue to get our collective a** handed to us on a paper plate.  There are only three ways to cut health care costs - cut care, raise premiums, or cut profits from those who make their livelihood (legitimate or not) from the system. (I guess a 4th would be to build a healthier population, but that's a complicated ball of wax.) Further "efficiency" is a myth, and is a term often used to justify just paying less to providers.

 

It's a sad, sad state of affairs.

[frogger]

But if the ONLY option was medicare, and everyone had it doctors would have to take it, or go out of business.

 

That may be true but with supply (where I live) so low and demand so high it would be nice to know the majority would stay in business! I don't see doctor's books. I can't tell you if they are just raking in the cash or if there would be a lot quitting. Knowing what I know of the health care industry I would skeptical if someone told me they did.

 

I think most of us do see the need to find a way to exert downward pressure on prices since we do not have an open market (in our state you have to file for a certificate of need for providing a service). We had two hospitals fighting over permission to build a few extra beds despite the fact their are only two major hospitals (often overflowing) for the general public in our biggest city. Also, it is really hard to shop around when they refuse to give you prices before the procedure is done. Imagine a mechanic doing that! He would get his socks sued off. So with our current environment there is no feasible way for consumers to exert that pressure even for optional or pre-scheduled things much for those in emergency situations.

[Lanny]

Perhaps, instead of spending the last six years wasting time and money proposing and voting on 60 bills to repeal the ACA, knowing that they'd get veto'ed, some of this time and money could have been spent thinking about how to improve it, instead of political grandstanding.

 

I told my DD this story, yesterday: We (Overseas American Voters) are covered by a law ("MOVE Act" or "Military and Overseas Voter Empowerment Act") that was done  in a Bi Partisan basis. One of my U.S. Senators (John Cornyn - R - TX) and Senator Chuck Schumer (D - NY) originated the bill, they got others to co sponsor it, it went through both houses and was passed and was signed  into law by the President.  THAT is how the system is supposed to work in Washington, DC.   Bi partisan sponsorship and support for legislation that helps the people. 

 

It is my understanding that all of the people who voted for ACA / Obamacare, are members of one political party. There was no bi partisan input.  

[Butter]

I haven't read all that's being said here, but everything I'm hearing about GOP intentions is "repeal and replace." I really doubt the intention is to leave a vacuum that would create an even bigger mess/crisis.

 

Yeah, I don't think they'd repeal with nothing to replace it with.  At least I hope they wouldn't.  From what I'm seeing it looks like Carson's idea of HSAs instead of (in addition to?) private insurance.  You'd go to whatever doctor and pay from your HSA.  It's complicated, though.  There'd still be Medicaid for the very poor.  Subsidies from the government would exist to fill the HSAs of cerain people.  There'd have to be some sort of nationwide provided catastrophic insurance that would either be provided for everyone or you'd somehow be forced to pay for (but those policies are often quite cheap).  The assumption is medical costs would go down because so many people would be on a cash basis.  No need to bill insurance.  Of course, there's the problem of a very strong insurance lobby and that's a lot of people put out of a job suddenly (people who work in insurance billing at the doctor's office right up to the CEOs of insurance companies).  I cautiously think it might be a good plan, but there are so many details that need to be hammered out.

 

Interestingly, it actually might end up being a step between what we have now and single payer.  It's generally conservatives who are more strongly against single payer so I wonder if they will either not notice that it's a step between or decide it's okay because it's being presented by Republicans.

 

It is my understanding that all of the people who voted for ACA / Obamacare, are members of one political party. There was no bi partisan input.  

 

Quite a lot of bills do not get bipartisan support (there was Republican input - there's a difference) nowadays.  Some of it is for good reason, some of it is political grandstanding.

[TechWife]

I hear what you are saying, but the reasons doctors won't accept Medicare is because Medicare doesn't pay enough to cover the costs (I'm not talking profit here) of seeing that patient. If you pay them enough to make it worthwhile, "premiums" (cost of funding) will jump tremendously.

 

 

 

It's been my experience that most doctors do accept Medicare. The elderly population makes up a large portion of their patient base. GP's and most specialists really have no option if they want to stay in business.

 

Options are more limited for Medicaid recipients than Medicare recipients. Medicaid pays far less than Medicare and so it can be difficult to find practitioners that will accept it. 

[Matryoshka]

I haven't read all that's being said here, but everything I'm hearing about GOP intentions is "repeal and replace." I really doubt the intention is to leave a vacuum that would create an even bigger mess/crisis.

 

Yeah, well I see Paul Ryan is already calling for dismantling Medicare as well, and turning it over to private insurance companies.  Who I'm sure will be rushing out to insure a bunch of sick old people for prices they can afford - especially since it could well be Social Security is next.  

 

People  think Obamacare would lead to 'death panels'?  This will just lead to 'so sorry you're sick, no way to pay for treatment, just die.'  

Edited November 11, 2016 by Matryoshka

[whitestavern]

I hear what you are saying, but the reasons doctors won't accept Medicare is because Medicare doesn't pay enough to cover the costs (I'm not talking profit here) of seeing that patient. If you pay them enough to make it worthwhile, "premiums" (cost of funding) will jump tremendously.

 

I am really curious to see what is going to be proposed to replace Obamacare...because we have a very unhealthy population in the U.S. where many people require very expensive care. We subsidize low-nutrient, highly-sprayed monocrops which end up in processed foods, import many of our vegetables long distances, and then wonder why costly degenerative diseases are springing up in more and more people. Insurance companies and pharmaceutical companies make billions of dollars in profits, yet no one - not even the new Administration - will touch that, after all, corporate profits are the cornerstone of the "free market".

 

Until American people can get a grip on the fact that both political parties largely serve corporate interests over what is good for the common people, we will continue to get our collective a** handed to us on a paper plate. There are only three ways to cut health care costs - cut care, raise premiums, or cut profits from those who make their livelihood (legitimate or not) from the system. (I guess a 4th would be to build a healthier population, but that's a complicated ball of wax.) Further "efficiency" is a myth, and is a term often used to justify just paying less to providers.

 

It's a sad, sad state of affairs.

 

I can't like this enough.

[Happy2BaMom]

I think we will be going to an HSA system. But they won't address the corporate profit issue (either on the part of insurers or pharmaceutical companies, or the agribusiness companies) and it needs to have at least the appearance of lower cost/more efficiency (pay close attention to 'appearance'...that's going to be key), but really it will just result in a transfer of financial risk to the consumer. HIgh deductibles, lower premium, with lots that won't be paid for or will have maximum payment levels. Same for Medicaid. It will be important to keep the corporate overlords happy while convincing the little guys they are going to get a great deal for low cost due to the "efficiencies of the market".

 

To whomever remarked about the ACA being a one-party deal....you are correct. I am far more Left than Right but, even at the time, I thought that was a HUGE mistake. Although I don't know what the President could have done at that point, since the Republicans had already pledged to not accept anything he put out. 

 

We are spending our time and money educating our kids (11 & 14) about maintaining their health, treating many conditions with home herbalism, and having languages and skills that will enable them to have a chance to work in other countries. I do not believe that they will have any type of health care coverage in this country that they will be able to afford long term, at least until some real fundamentals change, and that is nowhere on the horizon. 

Edited November 11, 2016 by Happy2BaMom

[Matryoshka]

To whomever remarked about the ACA being a one-party deal....you are correct. I am far more Left than Right but, even at the time, I thought that was a HUGE mistake. Although I don't know what the President could have done at that point, since the Republicans had already pledged to not accept anything he put out.

The idea for the ACA is actually based on a republican idea that came out of the Heritage Think Tank and was first implemented by Romney in Massachusetts.

 

I think the only reason Obama went with a plan like this is because it was originally a republican idea he thought the Republicans would be willing to compromise and actually get something passed vs. Single payer which was completely undoable because there's no way the Republicans would have let that go by. But of course as soon as Obama touched it it became the worst idea ever in the minds of the Republicans. It is a horrible idea and we really should have single-payer but again good luck getting that... and as much as it was a horrible fix it was still better than what was there before.

Edited November 11, 2016 by Matryoshka

[Guest]

People think Obamacare would lead to 'death panels'? This will just lead to 'so sorry you're sick, no way to pay for treatment, just die.'

We are already at that point. Thats why we have so many community fundraisers, and also people with no community who just use the ER until they die prematurely. Meanwhile we have people who are doing life extending at very high costs, because they have nothing to lose financially. And how many organ replacements on 97 year olds do you want to fund so they live to 200? All of us need access to affordable care, not a select group.

Edited November 11, 2016 by Heigh Ho

[Matryoshka]

We are already at that point. Thats why we have so many community fundraisers, and also people with no community who just use the ER until they die prematurely. Meanwhile we have people who are doing life extending at very high costs, because they have nothing to lose financially. All of us need affordable rates, not just some of us.

But the way to solve that problem as sure as heck is not to take (somewhat) affordable care away from people who already have it. Especially the elderly... we're all going to be old someday.

[KarenNC]

A problem some people I know have found with current HSA structures (HSA combined with high deductible or catastrophic insurance) is that if they try to pay the (usually lower) cash price for a service, it isn't counted toward their deductible.

 

It is also not heartening that NPR was reporting stock prices for pharmaceutical companies went up substantially after the election. 

 

http://www.marketwatch.com/story/drug-stocks-rally-health-insurers-tumble-as-investors-prepare-for-president-trump-2016-11-09

 

 

[Happy2BaMom]

The idea for the ACA is actually based on a republican idea that came out of the Heritage Think Tank and was first implemented by Romney in Massachusetts.

 

I think the only reason Obama went with a plan like this is because it was originally a republican idea he thought the Republicans would be willing to compromise and actually get something passed vs. Single payer which was completely undoable because there's no way the Republicans would have let that go by. But of course as soon as Obama touched it it became the worst idea ever in the minds of the Republicans. It is a horrible idea and we really should have single-payer but again good luck getting that... and as much as it was a horrible fix it was still better than what was there before.

 

I agree, and you are correct on Romney & Heritage. But Obama did eventually ram it through, without a single Republican yes vote....not that I blame him, but from that point on, Obamacare became the.... jihad isn't the word I want, but something like that...for the Republican base, with all the hyperbole about slavery and death panels. And now it will be scrapped, although I am very grateful that 20 million + Americans had access to care they did not before, at least for awhile. 

 

Democrats want the government to provide all the answers and solutions for health care, regardless of cost. Republicans are better at the sleight-of-hand, of offering smooth words while pushing more and more financial risk and offering fewer and fewer services to the average American, regardless of how many more people then get pushed into long-term poverty. (just my observation on those). No one is changing the fundamentals of the game. 

[Guest]

But the way to solve that problem as sure as heck is not to take (somewhat) affordable care away from people who already have it. Especially the elderly... we're all going to be old someday.

That is why people want the ACA changed. Affordable health care was taken away from working families. Instead of a PPO, they now have plans with high deductibles that they cant afford. They dont have 10k out of pocket each year to pay in addition to their premiums, in return for an annual and catastropic.

 

Look at car insurance. You have an accident, you have medical. Same injury not in the car, same catastrophic odds, and you are out an oop app 10k.

Look at rates for an elder vs working family. Lasik or IOL is 5k for a nonelder who was born or developed high myopia in childhood, not covered by medical insurance. Cataract surgery with IOL is pennies in comparison for an elder. Similar procedures, similar costs, but the nonelder is getting nothing for his insurance premiums while he has a need. Neither person can see well without the surgery, but only one can have the procedure using their medical insurance, while the denied person pays for it. Immoral.

Edited November 11, 2016 by Heigh Ho

[purplejackmama]

But the way to solve that problem as sure as heck is not to take (somewhat) affordable care away from people who already have it. Especially the elderly... we're all going to be old someday.

Where does one find this (somewhat) affordable care? My family needs it.

[MaeFlowers]

Does anyone have any idea what making insurance companies not for profit or turning them into co-ops would do?

Generally, I'm not big on govt involvement in business but when something like insurance is law, and generally unaffordable to the public, I don't see why we don't force their hand.

 

As a aside...both Trump and Pence have said that coverage for preexisting conditions should continue. Trump also has said that pharmaceutical companies should be taken to task over prices. I don't know if they are blowing smoke. I guess we can only wait and see.

[ChocolateReignRemix]

Dr. and Pharmacist. He now buys his RX from Canada. Are you saying my father or the medical professionals are lying?

 

Someone is. 

 

A Medicare or Medicaid provider cannot accept cash payment for a covered service.  Any non-covered service is not part of the contract Medicare has with the provider and falls completely on the patient.

 

https://www.medicare.gov/what-medicare-covers/not-covered/item-and-services-not-covered-by-part-a-and-b.html

 

"Medicare doesn't cover everything. If you need certain services that Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers these services."

 

Just applying a bit of logic and you should be able to figure this out via the existence of supplemental coverage available for Medicare.

[TechWife]

Someone is. 

 

A Medicare or Medicaid provider cannot accept cash payment for a covered service.  Any non-covered service is not part of the contract Medicare has with the provider and falls completely on the patient.

 

https://www.medicare.gov/what-medicare-covers/not-covered/item-and-services-not-covered-by-part-a-and-b.html

 

"Medicare doesn't cover everything. If you need certain services that Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers these services."

 

Just applying a bit of logic and you should be able to figure this out via the existence of supplemental coverage available for Medicare.

Exactly.

[TechWife]

Yeah, well I see Paul Ryan is already calling for dismantling Medicare as well, and turning it over to private insurance companies.  Who I'm sure will be rushing out to insure a bunch of sick old people for prices they can afford - especially since it could well be Social Security is next.  

 

People  think Obamacare would lead to 'death panels'?  This will just lead to 'so sorry you're sick, no way to pay for treatment, just die.'  

 

I think I might throw up. My mother is 86 years old and has social security as her only income. She cannot afford private insurance. Medicare is the best insurance she's had in her entire life. 

[NoPlaceLikeHome]

I am not trying to be political, but I really feel for those of you who are affected currently by ACA healthcare.

 

I am told we will ALL be affected at some point.

 

What I can't find is info on what can be done to change it.  Can the next president change it?  

Actually all of us have been affected for decades but have been unaware due to employers paying for the bulk of our premiums and due to being too young to remember or not aware of what was happening in the three decades or so. Instead many folks choose to blame the ACA wrongly IMO which was a Republican idea to begin with since Republicans cannot stand the idea of universal healthcare or medicare for all.

 

The CEO's of the hospitals I worked for told us every year that premiums were increasing 20 to 50% every year back in the early 1990's long before Obamacare. Why do you think Hillary proposed healthcare reform back in the early 1990"s and then was vilified ever since then for not acting like a pretty little first lady.

 

The only thing that will solve our problems is medicare for all or some other sort of universal healthcare and giving our public health insurance the power to negotiate for reasonable prices.

 

The republican solution is not a solution at all since allowing for insurance to cross state lines will only result in all insurance companies going to the states where they are allowed to gouge the consumer as much as possible and allowed to cover as little as possible. This has already happened with credit cards which is why most of them are located in Delaware and Nevada from what I recall.

[NoPlaceLikeHome]

That is why people want the ACA changed. Affordable health care was taken away from working families. Instead of a PPO, they now have plans with high deductibles that they cant afford. They dont have 10k out of pocket each year to pay in addition to their premiums, in return for an annual and catastropic.

 

Look at car insurance. You have an accident, you have medical. Same injury not in the car, same catastrophic odds, and you are out an oop app 10k.

Look at rates for an elder vs working family. Lasik or IOL is 5k for a nonelder who was born or developed high myopia in childhood, not covered by medical insurance. Cataract surgery with IOL is pennies in comparison for an elder. Similar procedures, similar costs, but the nonelder is getting nothing for his insurance premiums while he has a need. Neither person can see well without the surgery, but only one can have the procedure using their medical insurance, while the denied person pays for it. Immoral.

Affordable health care has been gradually being taken away from families for the past 3 decades long before Obamacare for the record. It is just that many did not realize how much their premiums went up every year long before Obamacare because our employers picked up most of the tab but are now doing so less so since premiums have been increasing much more than the rate of inflation for the past 3 decades every year.

 

Our family paid 1300/month for health insurance on the individual market 13 years ago in fact. Also, my son and I were turned down for coverage by several companies on the individual market even though we never had a lapse in coverage and have always been covered.

 

Also, you can thank conservative thinkers for high deductible plans since their theory was it would prevent folks from using medical care unnecessarily. Well instead high deductible or catastrophic plans often keep folks from seeking routine preventative care and care for chronic health conditions since they cannot afford it. Then they end up in the hospital with emergency situations costing a heck of a lot more than routine care and ongoing care for chronic conditions.

 

As for $10,000.00 for a castastrophic illness, you figure is way too low. I took care of plenty of previously healthy people who racked up hundreds of thousands of dollars in bills 20 years ago. I hate to think of what their bill is now!

[frogger]

Only dealing with how to pay or who pays won't help everyone. It may help this or that individual but society will still be paying the high cost. We need to deal with the actual cost of care not just how to pay for it.

 

I took my son to a local provider rather than the ER for his stitches to save money. 40 minutes and some thread, a needle, rubbing alcohol, cotton and bandage cost over $1000. It would easily been over twice maybe 3 times that at the ER. Both ER's in our state have groups of doctors that are separate from the hospital and choose the rate they charge. They are monopolies since private doctors can't work there. It is billed separately from the hospital so I could see that the doctor cost 3x's as much as the hospital (including payment for building, cleaning, nursing staff, equipment), the separate x-ray technician bill, EKG bill. You would think the doctor would be the cheapest bill since he didn't do much compared to all the technicians, didn't have to pay for equipment, or deal with the room before or after, scheduling, nursing, etc. They are a monopoly and are gouging big time but if we only focus on who pays then we aren't dealing with the root of the problem which is doctors using state governments to prop up monopolies or pharmaceutical companies charging obscene amounts because they can per government enforcement. When deregulation is spoken of it is never dealing with enforced monopolies, only payment procedures. Also the fact that people can't shop around because you aren't allowed to see the cost before you are treated (fought this battle a lot) doesn't help.

[maize]

Affordable health care has been gradually being taken away from families for the past 3 decades long before Obamacare for the record. It is just that many did not realize how much their premiums went up every year long before Obamacare because our employers picked up most of the tab but are now doing so less so since premiums have been increasing much more than the rate of inflation for the past 3 decades every year.

 

Our family paid 1300/month for health insurance on the individual market 13 years ago in fact. Also, my son and I were turned down for coverage by several companies on the individual market even though we never had a lapse in coverage and have always been covered.

 

Also, you can thank conservative thinkers for high deductible plans since their theory was it would prevent folks from using medical care unnecessarily. Well instead high deductible or catastrophic plans often keep folks from seeking routine preventative care and care for chronic health conditions since they cannot afford it. Then they end up in the hospital with emergency situations costing a heck of a lot more than routine care and ongoing care for chronic conditions.

 

As for $10,000.00 for a castastrophic illness, you figure is way too low. I took care of plenty of previously healthy people who racked up hundreds of thousands of dollars in bills 20 years ago. I hate to think of what their bill is now!

I think the $10,000 figure is meant to represent the deductible of a high deductible plan, what the consumer would have to pay before insurance kicked in.

[NoPlaceLikeHome]

On the 6 P.M. ET news from the USA tonight (10 NOV 2016) there was a discussion, about what will be involved, when they try to fix/improve or replace ObamaCare. Within the almost 3000 pages of the legislation (which nobody in the U.S. Senate or House of Representatives read, before the legislation was passed into law) there is, woven into Obamacare, a lot of stuff that impacts funding for the Medicare and Medicaid entitlement programs. It will be VERY tricky, to try to fix/improve or replace ObamaCare, without adversely affecting Medicare and Medicaid, which are huge entitlement programs used by tens of millions of Americans each day.                           i

Congressmen do have staffers to read and dissect these things for them so I am not buying that they did not read it since at the very least their staff read it and advised them on it.

 

Secondly, the Republicans made many, many amendments to the law and helped squash the public option being offered as a choice on the healthcare markets. Let us not forget that the whole mandate thing was a conservative idea supported by republicans until Obama proposed going with it as a conciliatory gesture.

 

Third, I really think using the term entitlement has negative connotations since it implies that folks feel "entitled" to healthcare instead of people actually deserving health care as a human being.

 

My 2 cents.

[frogger]

Every high deductable plan I have been on(and I always choose high deductable if I can as the numbers were always equal even if I used the entire deductable) pays 100% well check ups, vaccinations, and sometimes (not always) routine blood work, etc.

[maize]

Third, I really think using the term entitlement has negative connotations since it implies that folks feel "entitled" to healthcare instead of people actually deserving health care as a human being.

 

 

I understand that we do sometimes ascribe negative connotations to the word entitled, but entitlement is an accurate and appropriate term here--it means something people have been granted a legal right to.

http://legal-dictionary.thefreedictionary.com/Entitlement

Edited November 11, 2016 by maize

[Guest]

I think I might throw up. My mother is 86 years old and has social security as her only income. She cannot afford private insurance. Medicare is the best insurance she's had in her entire life.

What has been floated is essentially the government vouchering Medicare instead of administering it, complete with allowing purchasing of insurance across state lines, so the plans can be made genuinely competitive and vary in their coverage with need. Nobody on the left or right wants old people dying in the streets, that's silly. There has also been talk of expanding Medicaid risk pools to cover pre-d siting conditions on a need based, sliding scale, so that those who wouldn't fare well on the normal system can still get covered. It should still be a significant cost reduction even in fully covering a very sick person via taxpayers.

 

There are lots of good ideas that have been floated, assuming the absolute worst and most heartless outcome isn't really reasonable. Republicans get sick and have elderly family too. In our state it has consistently been the republican legislature proposing innovative, cost saving, quality improving medical changes and being blocked because of petty politics. Believe it or not these people exist in more legislatures than my own and even get elected nationally. There have been years of kicking around alternatives and cost benefit analyses for them, so the current congress and president should have a broad swath of options to consider and discuss.

Edited November 11, 2016 by Arctic Mama