Uninsured fundies and Obamacare

[OkToBeTakei]

yes...it's a good thing, but it is expensive. The USA has been behind most developed countries for quite some time in health care insurance for everyone. But affordable mean different things to different people...

The health care exchanges are only for people who don't get health insurance through their employer. So those are the people who the conversation needs to focus on. If you are below an income level, based on geography and family size, you will be eligible for the gov't to pay for a portion of your premium. For my family of 6 in Massachusetts, if our annual income is above ~95k then we will have to pay $1,015 each month for the most basic policy ~$12,180/year. that is 12.5% of our income. But, the out of pocket costs for deductibles and co-pays will add ~$3,000 to that~$15,000/year...and a big chunk of change.

I'm somehwhat familiar with the insurance in Germany. When I made less than 400 euro/month (~$540 at today's exchange rate) I did not have employer provided insurance. But when I went over that point, my health care withholding was ~15%. When I got a raise, my net income was lower b/c of the mandatory participation in insurance. in addition, my employer's costs went up ~7%. Business owners in Germany would advertise jobs with the "under 400 euro basis" disclaimer so the employee would know no health insurance was included. That is what some are predicting will happen...hours will be cut so the employer will not have to pay for health insurance...which will reduce incomes...which will increase the number of people the gov't will subsidize. Time will tell what happens.

With no insurance coverage, my daughter was treated at a German hospital for her scolosis. The appointment time was at 8:30. Well...not really, everyone with a morning appointment showed up at 8:30. You were put in a queue based on your arrival time and then spend the morning just waiting your turn. Or maybe we were put in the bottom of the queue since we didn't have insurance. Anyway, the first time, she was not seen until 11:30. But I got smart...the next time we arrived around 7:45 and only had to wait until 10. The average American will not be happy waiting for hours for dr appointments.

Is that the issue? Will folks not like waiting based on triage?

Triage is a huge part of NHS. If you are over 60 or under 10 you are a priority. I think that is sensible. Obviously if you arrive by ambulance that is a given.

Example some 10 years ago I ruptured my achilles tendon. I was triaged on arrival. Not much pain. Young and healthy. I waited 4 hours. In that time Isaw in the A&E some serious stuff. A Dad ran in with a floppy baby, an old man who looked grey. I felt Ok with my waiting.

I got plastered up, and re-plastered every week for 2months , then 2 months physio. It was all free. Should I have moaned about my initial 4 hour wait?

Is the issue expectation? Socialised healthcare is so part of my life I forget it is a cost for others and really cannot imagine it. It saddens me though that as you say the expectation is so..commercial?

[OkToBeTakei]

OKToBeTakei -- are you in Canada? Just curious. Yes, most other civilized nations have managed to get this to work.

No I am UK. Scotland specific. The proud country that eschews even prescription costs, denying the NHS of valuable money. Yet another personal hate :lol:

[pattygbucks]

Is that the issue? Will folks not like waiting based on triage?

In the ER of course triage rules...but this was not an emergency appointment at all.

There were so 20 kids all waiting to see the same orthopedic surgeon. No one I saw was in an emergency situation...some in cast, but very few if I remember right. These were appointments that were for consults and such. For my daughter, she was being seen to determine the degree of spine curvature and then evaluate if there was a need for further treatment.

[Coconut Flan]

That's the way the Air Force hospital did maternity patients. OB clinic was Tues and Thurs. The doors opened at 7:30 and everyone was seen in the order they signed in. If you asked for an appt, you got a card that said 8:00 or 8:15 because that was when they began lining people up.

[jenny_islander]

Really, unless you're going to a rich people's doctor where they coddle you because you're probably some other rich client's buddy, that's how it works out for most clinic visits in the U.S. Your appointment card may say "11:15," but if somebody ahead of you had extra questions or needed unanticipated care, you will sit there until the doctor is ready.

[GawkingToo]

The average American will not be happy waiting for hours for dr appointments.

The average uninsured American already does. It's called the emergency room.

[WonderingInWA]

The average uninsured American already does. It's called the emergency room.

The average insured American also waits for hours in the emergency room! The ER, from the outside, looks horribly efficient, but I think from the inside, they honestly are doing the best they can to get everyone constantly reprioritized. It's crazy.

[OkToBeTakei]

In the ER of course triage rules...but this was not an emergency appointment at all.

There were so 20 kids all waiting to see the same orthopedic surgeon. No one I saw was in an emergency situation...some in cast, but very few if I remember right. These were appointments that were for consults and such. For my daughter, she was being seen to determine the degree of spine curvature and then evaluate if there was a need for further treatment.

Would it annoy you if it was free? I can understand if you are paying. I just feel it's an attitude thing. Not you, please, please do not think that.

I took my Mum for her regular check up for glaucoma. We just make a trip out of it. Get coffee read the crap HELLO magazines. Go to the garden centre after. Part of life you may wait an hour or so.

(Aside I was diagnosed with a mild scoliosis in my 30's. Back pain. Hope your kiddie does not have pain.) They check my kid for it now. Also due to my Mum's glaucoma we get free eye tests.

[salex]

My state, Massachusetts, that has been doing this concept for awhile (Romneycare ;-)

unsubsidized lowest rate for family of 6 is $1,015/month for income more than ~$95/year

I don't understand why we didn't go with a plan like the most successful state plans

[GawkingToo]

The average insured American also waits for hours in the emergency room! The ER, from the outside, looks horribly efficient, but I think from the inside, they honestly are doing the best they can to get everyone constantly reprioritized. It's crazy.

Ha, ha. True, true. What I was getting at, though, is that uninsured people are the ones most likely to use the emergency room for non-emergency care, as that's the only place that can't turn them away. And since their issues aren't true emergencies, they're the ones who wait the longest. So my point was that the average uninsured American already waits for hours at a typical doctor's visit, because the only doctor they get to see happens to be the ER.

(Before someone jumps on it, my original comment was intended to be somewhat tongue-in-cheek. I don't know what the actual statistics are. I've heard that "urgent care" centers are rising in popularity among those who lack insurance but have the cash for a quick drop-in visit, but I don't know how much of a dent they make.)

[OkToBeTakei]

That's the way the Air Force hospital did maternity patients. OB clinic was Tues and Thurs. The doors opened at 7:30 and everyone was seen in the order they signed in. If you asked for an appt, you got a card that said 8:00 or 8:15 because that was when they began lining people up.

My midwife came to my house for my appointments. After 34 weeks. Before that I had to go there....THE HORROR!

She then came every day for 14 days post partum, I kind of fell in love with her when she told me about arnica gel. Even loved her more when she removed every second stitch of my 22. Hero.

After 14 days you get a Health visitor. I hated her. Such is life. But I will never knock the care.

She told me my baby was 'learning challenged' at age 2. Her reason was when I answered can she walk up stairs I answered 'No idea' We lived in a flat. ( all on one level)

Don't knock the system but some are just tick box idiots :lol:

I also faked the post partum depression thing. I actually helped develop it in a former life. Too funny. I told her though that as a Mum of a young child dealing with a bereavement, there are no boxes you tick. You just are.

[OkToBeTakei]

Ha, ha. True, true. What I was getting at, though, is that uninsured people are the ones most likely to use the emergency room for non-emergency care, as that's the only place that can't turn them away. And since their issues aren't true emergencies, they're the ones who wait the longest. So my point was that the average uninsured American already waits for hours at a typical doctor's visit, because the only doctor they get to see happens to be the ER.

(Before someone jumps on it, my original comment was intended to be somewhat tongue-in-cheek. I don't know what the actual statistics are. I've heard that "urgent care" centers are rising in popularity among those who lack insurance but have the cash for a quick drop-in visit, but I don't know how much of a dent they make.)

Do they still have to pay?

[GawkingToo]

Do they still have to pay?

They get a bill from the hospital. An astronomical bill. But if they don't pay, it's not like the hospital can come and repossess the medical care. The unpaid bills will get reported on the person's credit history and possibly also sold to third-party debt collectors. In some states, debt collectors (whether the hospital or a third party) can garnish a person's wages for unpaid debt. Medical debt is responsible for a lot of people declaring bankruptcy, too.

In the end, the hospital doesn't get paid. Sometimes, if the patient applies to the hospital's charity program, the hospital will greatly reduce the bill and allow the patient to pay in installments.

The hospital gets a write-off for the unpaid bills (even if an inflated amount was charged for this exact purpose), the person's credit takes a hit (but it might suck already), and the person may or may not pay some amount.

One wrinkle is that recently the federal government gave states the option of expanding Medicaid to healthy, low income adults. (Before that it applied only to low-income pregnant women, children, and some disabled people and to a small handful of super low-income healthy, non-pregnant adults.) The thing is, the states have to opt in. The federal government has agreed to pay the vast majority of the cost of expanding coverage (at least for a certain number of years; I don't recall the details). Many, many states, including mine, have refused to expand coverage. Because that would be, like, big government. So in many places it's still very hard for healthy but poor adults to get non-emergency health care.

(Someone correct me if I'm wrong on any of these points.)

[OkToBeTakei]

They get a bill from the hospital. An astronomical bill. But if they don't pay, it's not like the hospital can come and repossess the medical care. The unpaid bills will get reported on the person's credit history and possibly also sold to third-party debt collectors. In some states, debt collectors (whether the hospital or a third party) can garnish a person's wages for unpaid debt. Medical debt is responsible for a lot of people declaring bankruptcy, too.

In the end, the hospital doesn't get paid. Sometimes, if the patient applies to the hospital's charity program, the hospital will greatly reduce the bill and allow the patient to pay in installments.

The hospital gets a write-off for the unpaid bills (even if an inflated amount was charged for this exact purpose), the person's credit takes a hit (but it might suck already), and the person may or may not pay some amount.

One wrinkle is that recently the federal government gave states the option of expanding Medicaid to healthy, low income adults. (Before that it applied only to low-income pregnant women, children, and some disabled people and to a small handful of super low-income healthy, non-pregnant adults.) The thing is, the states have to opt in. The federal government has agreed to pay the vast majority of the cost of expanding coverage (at least for a certain number of years; I don't recall the details). Many, many states, including mine, have refused to expand coverage. Because that would be, like, big government. So in many places it's still very hard for healthy but poor adults to get non-emergency health care.

(Someone correct me if I'm wrong on any of these points.)

It makes my head explode.

Back to the question. Is affordable healthcare really better.....anything is better. I suppose?

Would the premise of the NHS work in the US? Did we just do it before people noticed. I think that is why it succeeds. I do honestly think it would be unworkable as a premise now. HOW in this political climate could you get by that. 50 years ago.....Obama is trying now..I admire his dream.

[gustava]

Will subsidize "some" individuals and families.

Family of 2 making more than ~65K/year nope----at least when I entered my state, etc.

Yes, you are correct that AHCA will subsidize some though not all.

[JMarie]

I don't understand why we didn't go with a plan like the most successful state plans

Exactly. It's not like the Massachusetts state government is rambling on about repealing Romneycare, leading to the conclusion that it's a successful and well-liked program. Why can't the rest of us enjoy such a program??

[pattygbucks]

Would it annoy you if it was free? I can understand if you are paying. I just feel it's an attitude thing.

Annoy me...not really, but that type of thing doesn't. When I have the wait times with my kids, we read, play cards, get hot chocolate from the vending machine and enjoy conversation. I'm fortunate to be a full time mom and she is my youngest, so time is "different" for me. Taking off work and/or paying for childcare is a big issue for many Americans.

Americans live to work...Europeans work to live. Germans enjoy life completely different way than we do...especially on Sundays: stores are closed, you can't mow your lawn (noise), families take walks & bike rides...truly a family friendly culture

[Stephanie66]

I am very happy to live in Minnesota. I was uninsured when I was diagnosed with breast cancer, and the state had already expanded Medicaid. If I lived in another state, it would be very difficult to obtain any sort of coverage after being diagnosed.

[Black Aliss]

The Affordable Care Act is not really that long a read, if you are interested. Yes, it is 2000-some pages but that's because of the formatting requirements of any piece of legislation. In actual word count it's about the same length or less, than one of the Harry Potter books. And it's certainly not a very difficult read, again, if you are interested.

It's okay, as health care legislation goes, but it's not universal coverage, single-payer. It's a start.

[Mama Mia]

Is that the issue? Will folks not like waiting based on triage?

Triage is a huge part of NHS. If you are over 60 or under 10 you are a priority. I think that is sensible. Obviously if you arrive by ambulance that is a given.

Example some 10 years ago I ruptured my achilles tendon. I was triaged on arrival. Not much pain. Young and healthy. I waited 4 hours. In that time Isaw in the A&E some serious stuff. A Dad ran in with a floppy baby, an old man who looked grey. I felt Ok with my waiting.

I got plastered up, and re-plastered every week for 2months , then 2 months physio. It was all free. Should I have moaned about my initial 4 hour wait?

Is the issue expectation? Socialised healthcare is so part of my life I forget it is a cost for others and really cannot imagine it. It saddens me though that as you say the expectation is so..commercial?

This is what I don't understand about people who complain about wait times, its not like its any different under the U.S. private system. When I've had to go to the emergency room or urgent care for myself or my kids the wait has ranged from 10 minutes to 8 hours, depending on what was wrong and how busy they were.

When I've had to get a new patient physical with a general practitioner the wait has been up to 3 months, but has been as a little as a week, depending on how popular the doctor is. The same with specialist care, the wait for a new patient rheumatologist visit through my medical group was 4 months.

If I didn't have insurance the wait would be forever, because I couldn't afford to go.

I think the main group who doesn't benefit from some portions of the affordable care act are self-employed families with incomes that look relatively high so they dont receive any subsidies, but they live in a high cost area so can't afford it. That is a big problem, IMHO, with many government systems. $100,000 in some parts of the country will make you wealthy, in some areas you would be comfortably middle class...but in high cost areas after you pay 2,000 for daycare, 2,000 for rent and another 2,000 in taxes there really isn't room for 1,000 + in health insurance.

[thekate]

Here's a link to the WP's ongoing Q&A about Obamacare.

http://live.washingtonpost.com/countdow ... acare.html

On a personal note, I am excited for Oct. 1 because right now we pay almost 30% of our income for some pretty bad insurance.

[WonderingInWA]

Here's a link to the WP's ongoing Q&A about Obamacare.

http://live.washingtonpost.com/countdow ... acare.html

On a personal note, I am excited for Oct. 1 because right now we pay almost 30% of our income for some pretty bad insurance.

Thanks for this link! If you have time, there are a lot of really good questions. I think what I'm learning is that every one of us is in our own unique situation (I have yet to find anyone in mine, but I did end up sending them a question, so hopefully they will address it).

Also, does anyone know if a person is on Medicare (my mother has Alzheimers and that's the only insurance she has), can they add ACA as supplemental?

[shaylahc]

I wanted to chime in here...don't know much about Obamacare, but I have plenty of experience with healthcare. I have lupus, and my daughter was born with a solitary kidney and had high grade reflux (surgically corrected, has autism, and endured many, many months of various therapies (OT, feeding, speech, etc). My husband left his last job almost exclusively because of the medical insurance--we could not afford the $1200 a month in premiums (for an 80/20 plan) for our employer sponsored insurance (through IBM). My daughter had surgery in Feb and the COPAY for her procedure was $6000. No one can afford that.

As far as Nationalized Health Care....I am all for it. I think Obamacare is stupid and just prolongs the inevitable. No one can afford the insane prices for medical care. Our current insurance does a "medical spending account" and deposits a chunk in at the beginning of the year. This forces us, as consumers, to spend our dollars more wisely. So every time someone in my family needs a test/procedure/specialist, I have to call around like I'm calling for a car repair quote, to make sure I'm getting the best deal. I think insurance companies LOVE this, because you're doing all the legwork for them, getting the best prices. In the end that saves them money, and I really think this is the future of healthcare...force it on the consumers to do the dirty work for you.

I also discovered that as someone who has a high deductible insurance plan, that pharmacies will charge you higher prices. I now use GoodRx for my generic meds, using my insurance I would be paying hundreds more.

Also as far as waiting---we all wait, even in the US. I took my kid to Urgent Care the other day (because her PCP does not take urgent appointments anymore) and waited 2 hours. When I wanted an appointment to see a lupus specialist, I waited 6 months. When my ped made a referral to have my son evaluated for autism, the place I called told me, "I don't know that we'll ever have an available appointment for you, but we'll be glad to put you on the waiting list...."

And don't even get me started on all the children's therapies that aren't covered by anyone. My kids went without OT and ST for years because I could not afford it.

It seems like the only people who have a positive view of America's health care system are the ones who rarely use it. Anyone who has battled cancer, or a chronic disease, or has a disabled child, knows our system sucks.

Everyone deserves affordable, high-quality healthcare.

[countressrascal]

I will try to answer some of the questions that have been asked since I have been trained regarding the program. I work at a Federally Funded Health Care Clinic.

1) If you have Medicare you are not eligible for any type of subsidy even if you are paying for Advantage plan or additional insurance.

2) Each state has their own marketplace/exchanges, however they are all governed by the same coverage guidelines. Bronze level will reimburse 60% for your medical costs, Silver 70%, Gold 80% and Platinum 90%. However there is a cap on out of pocket expenses, $7500 for an individual and $12500 for a family per year. If the insurance company does not spend 80% of premiums on medical care they must rebate the policyholders the difference.

3) To have coverage by Jan 1st you need to enroll and pay your premium by Dec 15th. You have to do electronic funds transfer to pay for your coverage. This year they have expanded the open enrollment until March 30th however it still will take 30 days after enrollment to get coverage. If you lose your job or some type of life event happens that you need medical insurance outside of this time frame there is a process to get enrolled. On the other hand if you chose not to enroll and have a medical emergency you are responsible of the bill. Hospitals are going to be much more aggressive in collections, however the rules have not changed they still can not turn away anyone that requires medical care no matter if they can pay or not.

4) All plans will offer the same coverage, however you need to look at the network of physicians and hospitals that are in their network, some of the policies have a very narrow network either by region or hospital systems. Example - my patients have only one plan that they can use to receive care in the community-they still have the four levels to chose from.

5) Number of states has expanded their state sponsored insurance plans to cover childless adults that do not make 130% of federal poverty level; they would receive free or low cost insurance through those plans.

6) A couple big issues that this will resolve life time caps, if you have a pre existing condition they can not refuse coverage for a waiting period also they can not change you more, also your premiums can only go up as you age, Well Women exams are covered at no cost, except for your copay, also children under 25 can stay on their parent's plan.

I would suggest that anyone that is going to buy insurance through the marketplaces/exchanges check out the policies and see who is going to accept the insurance before signing up, also go the web site and complete the financial forms so you can see how much you will receive as a subsidy, each state is different.

FYI in the state of Arizona fundie health care plans that Dougie the tool, sells is not eligible for a subsidy because it is not registered with the State Department of Insurance. But is does count as insurance. Now here is the big issue with that policy is that hospitals or offices can demand money up front to cover unreimbursed care if it elective care. We have a couple of patients that have it, we make them pay monthly payment for maternity care because we have been burned so many times, like the time they paid $150 for a home delivery we had to sue the patient for the remaining amount.

[thekate]

Thanks for this link! If you have time, there are a lot of really good questions. I think what I'm learning is that every one of us is in our own unique situation (I have yet to find anyone in mine, but I did end up sending them a question, so hopefully they will address it).

Also, does anyone know if a person is on Medicare (my mother has Alzheimers and that's the only insurance she has), can they add ACA as supplemental?

I sent in a question too, because I'm in a special snowflake situation. Well, it's probably not truly special, but it's a lot more complicated than all the situations addressed in the generic FAQs!