I hate the ACA

[Ravin]

First, my husband was laid off 10 years ago and Cobra was $600 a month. If we opted not to have it, that was ok too. Now, it is illegal for us to not have insurance and we would be fined. AND, under the new ACA laws, our insurance was covering far less and cost more. The Cobra amount was $2000 a month. I decided to take a look at the healthcare.gov site. It took a long time to fill out and had tedious redundant questions. After I finally finished, it said we qualified and to call this number. I called and the lady wanted to go over the entire application with me. She accidentally deleted all my children so she said we would have to start over. I told her I would go online and add all the kids back in and call back. I carved out time to redo all that. Again, it directed me to call. I did. That woman went over the application without deleting anyone. Fine. But then she told me we would have a huge deductible and a $1000 a month premium, but that was just for the adults. The kids would qualify for medicaid so we needed to do another application for that. Realize my husband is out of work and only collecting some unemployment. $1000 a month is not possible. And since it came with a huge deductible, we would likely never be able to use it anyway.

 

I go over to apply for medicaid for the kids. This redefined redundant! Literally, I had to state what each person's relationship was to each person. I do not mean just DS15 is brother to DS12. I had to state DS15 was brother to DS12 AND I had to state separately that DS12 was brother to DS15. 7 of us in the household, all declaring their relationships to the other 6, that means 42 entries on how each person is related. This section was minor compared to the rest. I had to declare our home. Then I had to fill out a bunch of questions on what we use our home for, do we live there, etc etc. Except, each question had to be answered and then I had to click "done" and "next." I spent a few hours on this. Then, I got medicaid cards in the mail as well as several HUGE envelopes with tons and tons of things I was supposed to read.

 

Then someone calls me from the state to go over choosing a plan. I told them the kids got medicaid. They said they have to pick a plan anyway. And they had to ask me a series of questions to pick a plan. I said I saw the list and I just wanted to pick XYZ plan. They said I could not do that, i had to do the questionaire, over the phone with them. Then they informed me it would be 30-40 minutes per child and the questionaire had to be done separately for each child. In the end, my children got different plans so different places they were eligible to go. Fact is, where I live, the only place they can go and have covered is the ER.

 

Now, today, I get a call from the state telling me I had to do an orientation to medicaid. They said this would take 20 minutes per child! Not kidding! I told them I was busy and would be busy until after the holidays. 

 

The whole thing is degrading and time consuming. I would not even mess with it except I do not want to get criminally fined for not having health insurance.  I wonder how much they pay these social workers anyway? Because in the time I have put in this month alone on this and how much these social workers have been paid to give these mandatory over the phone lectures, I am guessing that my old COBRA payment could have just been paid and tax payers (which includes me) would save a bunch of money.

 

The cost of health insurance has been skyrocketing for decades. This is not the fault of the ACA.

 

The idiotic bureaucracy you encountered in applying for medicaid is a combination of the requirements the Feds put out for states to get the money for it from them, and the extra hoops lawmakers like to put in the way for the poor and unworthy to get assistance. Also not the doing of the ACA.

[poppy]

Just FYI, informal polls in my area indicate that lower to lower Middle income people and those with preexisting conditions benefited from Aca. However, those who are solidly middle class or higher were "penalized".

 

 

Sent from my iPhone using Tapatalk

 

I have read numerous articles about people not understanding that the health insurance benefits they receive are due to ACA.

[Tanaqui]

And he said "And it’ll be great healthcare for much less money. So it’ll be better healthcare, much better, for less money".

 

And there will be a car in every garage, and a chicken in every pot. AND NO MORE LAWYERS, amirite?

 

[Spryte]

And there will be a car in every garage, and a chicken in every pot. AND NO MORE LAWYERS, amirite?

Promises, promises.

[Peach]

I get that all the paperwork is a pain in the posterior. It absolutely is. But you never know when something major will happen. We had no inkling  of the epilepsy issue until he had a massive seizure during lunch at Fuddruckers and required EMT's and a 4 day hospital stay. Same with the emergency surgery - he developed an abscess and was in surgery 4 hours later. You absolutely cannot count on the fact that the kids might seem healthy, so you'll just pay for the occasional doctor visit. If not for Medicaid, we'd be looking at bills in  the six figure range by now. When something happens, that hour or two you spent on paperwork will be worth it. Even if nothing major occurs, the peace of mind will be worth it too.

[maize]

And really, if government administered healthcare were such a disaster, wouldn't there be all kinds of people clamoring to dismantle it in the countries where it is established?

 

Why is it that we just don't hear of people in the UK, or Canada, or Sweden, or, well, anywhere, demanding that their governments get out of the healthcare business so they can adopt a U.S. style private market system?

 

People calling for reforms and improvements to their government administered systems? Sure. There's always room for improvement. But getting rid of such a system entirely? Not a platform any politician would dare to run on because it would be immensely unpopular.

 

No-one except for, apparently, a large group of Americans, wants the stress of healthcare insecurity in their lives.

Edited December 27, 2016 by maize

[Ravin]

I honestly don't understand why the cost for the two of you was so high--unless that was NOT counting in the subsidy that you get based on income. (Because when my family of three was on it, our premium was about half of that.)

 

Medicaid used to be a one page application. Following the passage of ACA, it was changed and is something like 20 pages, in a font so small that it is difficult even for the seasoned workers to read and find information. NO ONE can be expected to read and complete the form in the way that it's meant to be completed.

 

And yes, this is just one more mess created by ACA.

 

The social workers do not get paid nearly enough for the work that they do. Many of the people at the 1-800 numbers, when they started, came from other government jobs and had NO clue what to do with the information on the forms. (Thankfully, that's changed over the past few years.) Unfortunately, they are at the mercy of a horrible law and software created by companies who know nothing about health care, government benefits, or much of anything else -- and each state implements different software. Efficiencies vary by county and vary by state, depending on any number of things, but one county can be fantastic with skilled workers, and the next county can be flying by the seat of its pants with one or two inexperienced workers whose only priority can be meeting deadlines without the knowledge of how the different rules work.

 

I know this because it was the only job I had that I have ever hated. I enjoyed working with the majority of my clients, but the regulations--which often contradicted other parts of the same law--were surely the worst thing the government has ever implemented. Ever.

 

Arizona's medicaid application was long, tedious, and complicated well before ACA. It's the state that causes most of that. Not ACA.

[Ravin]

they said our income was too low for a subsidy but too high for Medicaid for the adults.

 

If that is the case, you are probably exempt from having to have coverage.

[shawthorne44]

Janeway,  I am sorry you are being attacked by people here.  I just want to give you a internet hug, and to say Yes, I agree with you, it sucks.  

[Guest]

Janeway, I am sorry you are being attacked by people here. I just want to give you a internet hug, and to say Yes, I agree with you, it sucks.

Disagreement is not an attack.

[Renai]

I'm not even sure what the ACA opponents want at this point.

 

I haven't read the rest of the thread after this question, but I'll answer for myself.

 

To not be forced into insurance. We've been off and on Medicaid over the years. My dh has a variable job, that got increasingly worse after the mortgage crash. We've been going to the same clinic since I was pregnant with my 17yo. They accept all kinds of insurance, cash pay, and also have a sliding scale. With ACA, using sliding scale is not really an option because you have to have something, right?

 

So, I'm public school teacher. When I worked full time, we didn't qualify for Medicaid. That is fine. Except, we also couldn't afford the insurance plans (post-ACA). When I put the whole family on the plan, we literally did not have the money to pay the rent for two months. I finally was able to get my kids on Medicaid, and put dh and I only on the plan. With dh and I on the plan, we still couldn't afford to go to the doctor anymore. If we hadn't been forced to pay hundreds of dollars each month for insurance, we would have had the money to go to the doctor - sliding scale or no, which is what we'd done for years. As it was, we were forced to pay, could not take advantage of it (have those copays and deductibles - there is no extra money to pay that!), and they still didn't cover when dh did have to go to the hospital. A bill we were unable to pay. The insurance also didn't cover our meds. It was still out of our pockets, which meant we didn't get meds for a while, or took turns each month. Because after paying insurance, there was literally nothing left.

 

But, we had to have it. Afterward, I said forget it. One or more of the adults in this family may or may not have insurance. One or more may be using the sliding scale at the clinic. And one or more may be skipping the fine because it's not up to the federal government to make us pay for something we can't afford, and punish us for not being able to afford it. And no, the exemptions do not apply to the one or more adults in the family this situation applies to.

[Azalea]

My mother is 77 and my dad is 85. They are on Medicare and a supplemental insurance that costs $400 per month. In the last year, my dad has had a triple by-pass and hip surgery. If Medicare was going to ration, they would have rationed him. Can you imagine if he had been on an insurance plan before ACA? Even if he could have gotten insurance the moment he started having real problems he would have been dropped. Medicare is a miracle. My mother has had multiple health problems. Stroke, broken arm, multiple stays in hospital, a couple of weeks in a rehab. Between the two, they have probably cost $200,000 in the last year and Medicare has taken care of them wonderfully. No rationing! Next month, my dad will have cataract surgery. My parents are currently enjoying life. Viva Medicare! Let's make Medicare for all!

[poppy]

I haven't read the rest of the thread after this question, but I'll answer for myself.

 

To not be forced into insurance. We've been off and on Medicaid over the years. My dh has a variable job, that got increasingly worse after the mortgage crash. We've been going to the same clinic since I was pregnant with my 17yo. They accept all kinds of insurance, cash pay, and also have a sliding scale. With ACA, using sliding scale is not really an option because you have to have something, right?

 

So, I'm public school teacher. When I worked full time, we didn't qualify for Medicaid. That is fine. Except, we also couldn't afford the insurance plans (post-ACA). When I put the whole family on the plan, we literally did not have the money to pay the rent for two months. I finally was able to get my kids on Medicaid, and put dh and I only on the plan. With dh and I on the plan, we still couldn't afford to go to the doctor anymore. If we hadn't been forced to pay hundreds of dollars each month for insurance, we would have had the money to go to the doctor - sliding scale or no, which is what we'd done for years. As it was, we were forced to pay, could not take advantage of it (have those copays and deductibles - there is no extra money to pay that!), and they still didn't cover when dh did have to go to the hospital. A bill we were unable to pay. The insurance also didn't cover our meds. It was still out of our pockets, which meant we didn't get meds for a while, or took turns each month. Because after paying insurance, there was literally nothing left.

 

But, we had to have it. Afterward, I said forget it. One or more of the adults in this family may or may not have insurance. One or more may be using the sliding scale at the clinic. And one or more may be skipping the fine because it's not up to the federal government to make us pay for something we can't afford, and punish us for not being able to afford it. And no, the exemptions do not apply to the one or more adults in the family this situation applies to.

 

See post #101.  There really isn't any punishment for not having insurance coverage.  Or, there is one on the books, but it is not enforced. Hope that helps.

 

I hate the cost of insurance. It's awful. I wish it health insurance wasn't a profit generating business.  That's what really kills. That these constantly rising cost (including before ACA)  are that way in order to make  $$$$$.  I personally have mutual funds that invest in healthcare. (As does anyone with an index fund....)  It's a gravy train.

[Charlie]

Go back and read through my posts. I have repeatedly said people should not be put through this based on their income. It is not ok to diminish a person like this based on their income.

 

Oh for sure I see this throughout your comment. I was wondering why you don't respond to the comments that explain how this paperwork is not a consequence of the ACA but of legislation designed to make public assistance undesirable, and really only in selected states. I'm curious what you would think if it were only a ten minute phone call that assured the medical expenses of your family were paid, including a horrific (or not so horrific) accident, or something as unpreventable and random as appendicitis.

[Ravin]

Wow. Well, you're certainly welcome to keep your children uninsured. If your income is virtually zero except for unemployment, I'm pretty sure you're exempt from the fine. And no one is forcing your husband to collect unemployment, either. He's welcome to opt out if attending the orientation is too onerous.

 

First time I've ever heard someone complain about her children getting free health care. Now I've seen it all.

 

She's not complaining about getting free healthcare. She's complaining about the idiotic layers of bureaucracy, which as described are, yes, ridiculous. For example, the 20 minute "orientation" separate for each child? That's stupid. It's a waste of time and money. If there needs to be an orientation, one should cover all of them. Also, she should have been offered a plan that would work for all the kids to make it easy to take them all to the same doctor, etc. In Arizona we pick a plan, and there might be a screening questionaire if you aren't sure, but I knew which plans our established doctor and preferred hospital took and chose accordingly.

[Mergath]

She's not complaining about getting free healthcare. She's complaining about the idiotic layers of bureaucracy, which as described are, yes, ridiculous. For example, the 20 minute "orientation" separate for each child? That's stupid. It's a waste of time and money. If there needs to be an orientation, one should cover all of them. Also, she should have been offered a plan that would work for all the kids to make it easy to take them all to the same doctor, etc. In Arizona we pick a plan, and there might be a screening questionaire if you aren't sure, but I knew which plans our established doctor and preferred hospital took and chose accordingly.

 

She's also complaining about having to get it to avoid a fine, even though several of us have told her repeatedly that she isn't going to be fined because her income is too low.

[StephanieZ]

Since providing insurance is now required, companies don't see a benefit in providing it. It used to be worth the headache, but now it is just a burden.

 

FWIW, providing health insurance is not required for very small employers, like us, who have fewer than 50 employees. Tiny employers are exempt from the ACA and many other labor laws, actually. Even though under-50-employers is a very small employer, MANY people work for tiny businesses like ours and without the ACA, they had nearly no way to buy health insurance . . . So pre-ACA, as employers, we considered it a moral imperative for us to provide it, despite the mammoth headaches involved with it.

 

We were thrilled to drop the group plan once the ACA came out . . . BUT . . .

 

We've added a (ACA SHOP Exchange for small employers) group health plan back to our small business for 2017, after a 3 year hiatus while we and our staff were using the ACA individual exchange, because the ACA plans have deteriorated in both quality (decreased dramatically) and price (increased dramatically) over these 3 years . . . So, we're back to providing a small group plan, even with all the headaches . . . the headaches are smaller than pre-ACA, though, since pricing is now standardized through the ACA SHOP (small business) exchange, and the elimination of pre-existing conditions reduced our paperwork by 90%.

 

So, for us, the ACA SHOP exchange is now very valuable, but it serves just maybe 100k people nation-wide, so it's not being well utilized. . .

 

Anyway, health insurance *is* an important benefit to our little company to offer it, as it is a desirable benefit to our support ($10-$20/hr level) staff, and would be nearly critical to recruiting a full-time veterinarian . . . which we're considering doing this coming year. Our support staff did OK with the individual ACA plans for the first few years (and we had given raises to those whose ACA plan cost would have been higher than our prior group-plan individual cost share, so they weren't out actual $$) . . . but the ACA plans have fallen apart and the pricing has gone nuts. Back before the ACA, we felt that our provision of group health insurance (we paid about 80% of the employee cost, and it was an excellent plan) was an important recruiting and retention tool for our low wage staff, as very few of our competitors offered it. (Actually, none that I knew of.) The dental and vision insurance is really nice for staff, too, as most of our entry level wage staff have neglected their teeth for a long time, especially if they didn't come from well off families who took good care of the kids' teeth . . . 

 

The dang thing about health insurance is that it is critical, vital, extremely important, and also extremely complicated to understand and to shop for. It's just way too complicated, IMHO, for us mortals to be left to shop for without serious gov't oversight and regulations. . . I've got 12 years of experience managing it for our little business and our little family, and I've spent at least hundreds of hours researching plans, etc . . . and I guarantee that I can't possibly actually know what each plan covers or does not. You can't know what it really covers until you get the 100k bill from the hospital . . . THAT was the hugest most important benefit of the ACA, IMHO -- providing a floor that defines what is an acceptable level of coverage . . . so you could then shop/compare with some small bit of confidence that when you get sick, you will be covered, and not fall into some loop hole on page. 245 of your policy document . . .

 

Of course, all these small but meaningful improvements will likely disappear in coming months . . . and things will be even worse. . .  GREAT. Just GREAT. Things are going to be so GREAT in America . . . UGH. I'm so depressed. 

[Jenny in Florida]

I do not know anyone at all that benefitted from the ACA.  

 

My daughter has benefitted enormously by being allowed to stay on our policy until age 26. At her age (22), I was uninsured, because I had graduated from college but was not yet working in a job that offered benefits. She does not need to go through that.

 

I have a co-worker with a pre-existing condition. Because of her medical situation, she is not able to work full time and, therefore, does not qualify for insurance through our employer. However, she is able to afford coverage for herself purchased through the exchange with a subsidy, even though she has the pre-existing condition.

[Janeway]

Then complain about and to your state representatives. ACA did nothing to make them make you job through all sorts of hoops to get coverage. I live in a state that is great to Medicaid patients. The online application takes 10 minutes, spells out exactly what proof of income and identification you need to send them and once approved they send you a letter clearly stating how to pick your provider and PCP. They have a great system for people who still need help with the simple steps. There are of course computer and human errors at times that can make it a little more annoying but a quick phone call gets things sorted out.

 

It is the state you live in that is causing you these enrollment issues not the ACA.

I actually already did! LOL...seriously. I wrote letters and sent to the ones in my district, both state and federal.

 

edited to add: though, I do not think I am that eloquent so I wonder if what I was trying to say was even conveyed.

Edited December 27, 2016 by Janeway

[Ravin]

And there will be a car in every garage, and a chicken in every pot. AND NO MORE LAWYERS, amirite?

 

Now hold on just a minute...

[LucyStoner]

My mother is 77 and my dad is 85. They are on Medicare and a supplemental insurance that costs $400 per month. In the last year, my dad has had a triple by-pass and hip surgery. If Medicare was going to ration, they would have rationed him. Can you imagine if he had been on an insurance plan before ACA? Even if he could have gotten insurance the moment he started having real problems he would have been dropped. Medicare is a miracle. My mother has had multiple health problems. Stroke, broken arm, multiple stays in hospital, a couple of weeks in a rehab. Between the two, they have probably cost $200,000 in the last year and Medicare has taken care of them wonderfully. No rationing! Next month, my dad will have cataract surgery. My parents are currently enjoying life. Viva Medicare! Let's make Medicare for all!

Bizarrely, Speaker Ryan's plan for Medicare looks an awful lot like an ACA style marketplace exchange with government subsidies being paid to private insurers to provide care that the government is pretty efficiently and popularly providing now without any of the funds going to private profits. Irony much? If passed as is, it would replace the popular Medicare program (for future retirees) with something that people in his own party wish to repeal without replacing. So it's not good enough now, but it will be good enough for all of us when we retire and have more health issues.

Edited December 27, 2016 by LucyStoner

[Tanaqui]

Now hold on just a minute...

 

Well, I suppose we can have one lawyer. Round up all your legal buddies, it's time for an epic game of rock-paper-scissors.

[ktgrok]

The problem I am stating is obviously a by the state issue. Assuming you did not spend hours on getting and keeping the Medicaid, and you have been able to get doctors who take Medicaid, and pharmacies that take it, and in your state, middle ground people can get it. But for me, I have spent hours on the process of applying and keeping. Right now, I am owned by Medicaid as is my time. Putting someone through a 20 minute orientation per child is nuts. I have to sit and listen to the same 20 minute speech, 5 times. That is clearly done to send a message or have an agenda. No one can possibly think some one needs to listen to a twenty minute speech, 5 times in a row.

 

I should make a YouTube video to show how bad it is so you all can understand.

 

We get that it is bad. We are just saying that that isn't because of the ACA. The ACA has NOTHING to do with the application for medicaid in your state. 

[Tanaqui]

I actually already did! LOL...seriously. I wrote letters and sent to the ones in my district, both state and federal.

 

You should follow up with a phone call. The squeaky wheel and all that.

 

[Carol in Cal.]

 

Oh, and how very odd--Medicare has not made it impossible for those enrolled to also take advantage of secondary insurance and private pay options.

 

 

Our chiropractor has told us that once my husband goes onto Medicare she will no longer be allowed by the government to treat him, even though we pay privately for those treatments, because of Medicare regulations.  We pressed her on that point, because DH has a degenerative back condition and has really benefitted from her specific type of help.  Losing that because of government regs is going to really bite.  Again, we won't even be able to pay privately for this.

[Carol in Cal.]

Bizarrely, Speaker Ryan's plan for Medicare looks an awful lot like an ACA style marketplace exchange with government subsidies being paid to private insurers to provide care that the government is pretty efficiently and popularly providing now with any of the funds going to private profits. Irony much?

I don't see how he can recommend that, it's horrible.  Vouchers, and these seniors have to figure out which company to go with.  That'll work.  <end sarcasm>

[Carol in Cal.]

 

 

I know that there are some places where this kind of system is trustworthy, like Germany for example, but the US just doesn't have that kind of reliability in government that most of, say Western Europe or the Commonweath countries do.  I don't see us getting there, either.  It's really too bad.

I'm repeating the above for emphasis.

 

I would love to have a country with a trustworthy enough government to set up single payer and believe that it will be administered humanely, but I don't.  I KNOW how well it works in, say, Germany, or Canada.  I just don't believe that our own government is competent enough or trustworthy enough to avoid catastrophic episodes of people falling between the cracks, since I've seen that so much in other areas of our so-called safety net.  And the downside risk to that when it comes to medical care is significant.

[Guest]

Our chiropractor has told us that once my husband goes onto Medicare she will no longer be allowed by the government to treat him, even though we pay privately for those treatments, because of Medicare regulations. We pressed her on that point, because DH has a degenerative back condition and has really benefitted from her specific type of help. Losing that because of government regs is going to really bite. Again, we won't even be able to pay privately for this.

I thought this was discussed before and it is a misunderstanding??

[Guest]

I'm repeating the above for emphasis.

 

I would love to have a country with a trustworthy enough government to set up single payer and believe that it will be administered humanely, but I don't. I KNOW how well it works in, say, Germany, or Canada. I just don't believe that our own government is competent enough or trustworthy enough to avoid catastrophic episodes of people falling between the cracks, since I've seen that so much in other areas of our so-called safety net. And the downside risk to that when it comes to medical care is significant.

But, with the for-profit system we have now, buckets full of people are falling into the giant chasms! I honestly don't see how a government run system could be worse?

[ChocolateReignRemix]

Our chiropractor has told us that once my husband goes onto Medicare she will no longer be allowed by the government to treat him, even though we pay privately for those treatments, because of Medicare regulations.  We pressed her on that point, because DH has a degenerative back condition and has really benefitted from her specific type of help.  Losing that because of government regs is going to really bite.  Again, we won't even be able to pay privately for this.

 

Your chiropractor is a moron.

 

"Medicare doesn't cover everything. If you need certain services 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 them."

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

 

What I find really irritating is that you don't even take the time to research what you were told so you could sniff out the BS.

 

If a healthcare provider accepts Medicare, then they cannot provide any Medicare covered services to a Medicare patient for other payment.  Anything not covered by Medicare must be paid for with cash or other insurance.  Medicare is not contractually part of any non-covered services.

 

If a provider does not accept Medicare, a Medicare patient can still purchase services using cash or other insurance.  Medicare again is not contractually part of the transaction.

 

And yes, this was explained to you in another thread.

Edited December 27, 2016 by ChocolateReignRemix

[LucyStoner]

Our chiropractor has told us that once my husband goes onto Medicare she will no longer be allowed by the government to treat him, even though we pay privately for those treatments, because of Medicare regulations. We pressed her on that point, because DH has a degenerative back condition and has really benefitted from her specific type of help. Losing that because of government regs is going to really bite. Again, we won't even be able to pay privately for this.

Your chiro may be misinformed. I know a number of people on Medicare who receive chiropractic care, some as self pay and, in some limited circumstances, covered by Part B. Perhaps there's a state to state difference between yours and mine though.

[ChocolateReignRemix]

Your chiro may be misinformed. I know a number of people on Medicare who receive chiropractic care, some as self pay and, in some limited circumstances, covered by Part B. Perhaps there's a state to state difference between yours and mine though.

 

Medicare is federal and should not have differences between states regarding covered services.

[LucyStoner]

Medicare is federal and should not have differences between states regarding covered services.

While I get that, I was allowing for the possibility that my experience was not relevant to hers in some way.

[Tanaqui]

I would love to have a country with a trustworthy enough government to set up single payer and believe that it will be administered humanely, but I don't.  I KNOW how well it works in, say, Germany, or Canada.  I just don't believe that our own government is competent enough or trustworthy enough to avoid catastrophic episodes of people falling between the cracks, since I've seen that so much in other areas of our so-called safety net.  And the downside risk to that when it comes to medical care is significant.

 

I understand why you think that, but truly, I believe the reason our government has troubles is precisely because voters say "Well, they're not competent or trustworthy, so let's not give them the tools they would need to manage things correctly".

 

If our government fails, it's because it's not being allowed to succeed.

 

[ChocolateReignRemix]

While I get that, I was allowing for the possibility that my experience was not relevant to hers in some way.

 

If it were Medicaid then there could be a difference.  Medicare in GA = CA = NY as far as coverage provisions.

[Carol in Cal.]

While I get that, I was allowing for the possibility that my experience was not relevant to hers in some way.

My chiro is pretty welleducated, and not one of the wild haired anti-everything ones.  We have discussed this with her several times over the years.  I know that she believes this, and that she is rational in researching things.  And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing.  So I believe her.

[LucyStoner]

If it were Medicaid then there could be a difference. Medicare in GA = CA = NY as far as coverage provisions.

Some Medicare patients get Medicaid too and there are some instances where providers can't bill a Medicaid patient for anything not covered. Many people confuse Medicaid and Medicare so it is possible that that is the root of her chiro's misinformation. Still, healthcare providers should know better.

[maize]

I'm repeating the above for emphasis.

 

I would love to have a country with a trustworthy enough government to set up single payer and believe that it will be administered humanely, but I don't. I KNOW how well it works in, say, Germany, or Canada. I just don't believe that our own government is competent enough or trustworthy enough to avoid catastrophic episodes of people falling between the cracks, since I've seen that so much in other areas of our so-called safety net. And the downside risk to that when it comes to medical care is significant.

So...you prefer no safety net?

 

What kind of a non-government-administered safety net do you envision? One run by companies concerned primarily with their own profit perhaps?

 

This post really perplexes me. "Our safety nets don't have a perfect record so we're better off with no safety net" is what I am hearing.

Edited December 27, 2016 by maize

[LucyStoner]

My chiro is pretty welleducated, and not one of the wild haired anti-everything ones. We have discussed this with her several times over the years. I know that she believes this, and that she is rational in researching things. And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing. So I believe her.

The AARP and several professional organizations/publications of chiropracters have information and articles about Medicare patients recieving chiro care. All readily available online.

[ChocolateReignRemix]

My chiro is pretty welleducated, and not one of the wild haired anti-everything ones.  We have discussed this with her several times over the years.  I know that she believes this, and that she is rational in researching things.  And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing.  So I believe her.

 

So your chiro's opinion > than quotes from the Medicare website?

[SproutMamaK]

I'm repeating the above for emphasis.

 

I would love to have a country with a trustworthy enough government to set up single payer and believe that it will be administered humanely, but I don't.  I KNOW how well it works in, say, Germany, or Canada.  I just don't believe that our own government is competent enough or trustworthy enough to avoid catastrophic episodes of people falling between the cracks, since I've seen that so much in other areas of our so-called safety net.  And the downside risk to that when it comes to medical care is significant.

Our governments are not some bastion of truth and competence. They are full of corrupt politicians, self-serving policies, scandals, etc. You simply don't see those issues because it doesn't interest your media (unless it's amusing... anyone remember Rob Ford?). Despite the same shortfalls, our countries make it work because the people continually force the issue when things go wrong with the system. Sometimes even so people to fall through the cracks... but from what we see on the outside, your system is already catastrophic for many people. Even the worst "cracks" would be far better than what people face now.

[Tanaqui]

My chiro is pretty well educated, and not one of the wild haired anti-everything ones.  We have discussed this with her several times over the years. I know that she believes this, and that she is rational in researching things. And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing. So I believe her.

 

Rational, well-educated people can still make mistakes. How could they even enforce "people on Medicare can't be treated here even if they pay out of pocket"? Do you people in California have bar codes on your arms or something? Because here, if I show up to the doctor's office and say "No, actually, I'm not insured" they have no ability to determine whether that's the truth or not. Do you imagine that the government is standing around waiting to jump on people who claim to be uninsured to get sneaky chiropractic services out of pocket? Where is the funding for this even supposed to be coming from?

 

Actually, the more I think about it, the more ridiculous and irrational it seems. The government has no way to tell that you went into your chiro's office and didn't disclose that you use medicare or medicaid for your routine checkups. Neither does your chiro. Neither does any other doctor.

[ChocolateReignRemix]

Some Medicare patients get Medicaid too and there are some instances where providers can't bill a Medicaid patient for anything not covered. Many people confuse Medicaid and Medicare so it is possible that that is the root of her chiro's misinformation. Still, healthcare providers should know better.

 

You are being kind and generous, but even with the bolded being true (I don't believe it as non-covered services are specifically listed as a patient's responsibility, and legally the government cannot restrict your access to uncovered services), someone promoting themselves as an authority should know the difference between Medicare and Medicaid.

[ChocolateReignRemix]

My chiro is pretty welleducated, and not one of the wild haired anti-everything ones.  We have discussed this with her several times over the years.  I know that she believes this, and that she is rational in researching things.  And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing.  So I believe her.

 

Why haven't you researched it? 

[Tanaqui]

Why haven't you researched it? 

 

Because she trusts her chiro, I guess. Maybe it's me, but I check out pretty much any claim. Experience has shown me that people will say anything.

 

I'm still stuck on this. Carol, did you think about the implications of all this? The government that is too incompetent to be trusted to manage single payer health care suddenly became super competent at the job of tracking down illicit out-of-pocket medical expenses! It doesn't make any sense. Either the government can't manage to put its collective pants on the right way, or the government is super great at tracking down people who play the system, but it is extremely unlikely that both things are true at once. (It is, of course, highly possible that they're both false.) You gotta pick one, or maybe neither.

[justasque]

My chiro is pretty welleducated, and not one of the wild haired anti-everything ones.  We have discussed this with her several times over the years.  I know that she believes this, and that she is rational in researching things.  And I know that she would like to keep her clients into their Medicare years, so this is not something that she has benefit from believing.  So I believe her.

 

If her services are important to you and your dh, it might be worth doing a bit of research on your own, and giving her the info as well as the contact info for the Medicare people you've spoken to about it.  I believe that she believes that she is giving you accurate information.  She certainly would benefit from being able to take these patients.   However, we all know how hard it is to get a good, accurate, documented answer from a health insurance entity, government-run or otherwise.  It's certainly possible that she originally spoke to someone who either got it wrong or didn't understand what she was asking.  And if it's something she researched years ago and hasn't revisited, there may have been changes in the meanwhile.  I strongly encourage you to make a few calls to see if you can get a more recent, accurate answer, for your dh's benefit and for hers.

[maize]

Here's some information for chiropractors on working with medicare:

 

 

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf

[ChocolateReignRemix]

If her services are important to you and your dh, it might be worth doing a bit of research on your own, and giving her the info as well as the contact info for the Medicare people you've spoken to about it.  I believe that she believes that she is giving you accurate information.  She certainly would benefit from being able to take these patients.   However, we all know how hard it is to get a good, accurate, documented answer from a health insurance entity, government-run or otherwise.  It's certainly possible that she originally spoke to someone who either got it wrong or didn't understand what she was asking.  And if it's something she researched years ago and hasn't revisited, there may have been changes in the meanwhile.  I strongly encourage you to make a few calls to see if you can get a more recent, accurate answer, for your dh's benefit and for hers.

 

There is also the possibility the chiro has been involved with Medicare fraud in the past and an no longer accept Medicare.

 

My main issue with what the chiro is claiming is that Medicare patients cannot legally seek non-covered services elsewhere, which has never been the case and is not something this person could have ever been told as it is pure nonsense.

[Carol in Cal.]

I understand why you think that, but truly, I believe the reason our government has troubles is precisely because voters say "Well, they're not competent or trustworthy, so let's not give them the tools they would need to manage things correctly".

 

If our government fails, it's because it's not being allowed to succeed.

OK, let me give you an example of what I mean.

 

An elderly lady, a little 'off' lived in our neighborhood in a house that was basically falling down around her.  Every time it rained she would be observed carrying huge washbuckets of water, presumably leaked in through the roof, outside to dump them out.  Her home was ground zero for mice for the neighborhood to such at extent that we saw them inside, between her window and her shade during the day.  The front yard was so overgrown that people on her block didn't realize that she had a garage door up front.  The chimney was pulling away from the side of the house.   

 

I researched the ownership of the house--it was owned by a trust that was administered by her nephew--because I was really worried about her safety.  Everyone in the area kind of quietly watched out to see if she was around.  If she didn't appear for a few days someone would go knock on the door to make sure she was not fallen or trapped.  No one wanted to be all up in her business, but the safety issues were kind of shocking.  We knew that she wanted to live there because it was where she and her husband had lived for many years.

 

So I talked with someone at the city about it, anonymously.  I described the situation, and she told me that if the city got into that house it would be red-tagged as not habitable, that the trustee would be subject to landlord laws around habitability, and that he would be forced to repair it.  She pushed me really hard to tell her where it was.  She argued that if there were big active roof leaks there was a danger of an electrical fire, with tragic possible results.  But, KEY POINT, she could not say that the woman would not end up homeless.  She kept saying that there were city programs for senior housing that would apply while repairs were done.  But when I asked her, can you guarantee that she will be able to go into senior housing or some temporary placement the day that you redtag her home?  the answer was no.  And we didn't even discuss the complication of her big pet dog. 

 

See, in Germany that wouldn't happen.  The city official or social worker would have TAKEN RESPONSIBILITY to ensure that the move was seamless.  Anything less would have been inhumane.  But here, we do inhumane things all the time to our most vulnerable people, and so no, I don't trust that mindset with medical care for all.  It's not a question of inadequate funding as much as it is an attitude of lack of responsibility.

 

Edited December 27, 2016 by Carol in Cal.

[maize]

Also FAQ FOR chiropractors:

https://www.kmcuniversity.com/medicare/faq

 

If you go to The official Medicare website and look up chiropractic care, it lists covered services and states that patients would pay out of pocket for other services. There is nothing--NOTHING--indicating any patient could not go to any chiropractor and pay for a service they desire. If it is a Medicare covered service the provider is required to bill Medicare--perhaps yours does not want to do that. Which would be entirely on their shoulders not Medicare's.