This topic is suggested by David Lurie of Ocean Grove who has included a link to the New York Times, December 9, 2013 issue. The paragraph below is written by him:
“Worth reading. Here are some examples of the actual people who are being helped, and who have been paying huge prices for our current system of providing (or not providing) care. I found telling the example of immigrants from China who – as children – had to return there for medical treatment and pharmaceuticals. The cancer patient who was skimping on his chemo was more than a bit disturbing as well. These realities, it seems to me, need to be reckoned with by anyone who want to nullify the ACA.”
Here is the link from today’s NY Times.
Amid the Uproar Over the Health Law, Voices of Quiet Optimism and Relief
Blogfinger Medical Commentary: By Paul Goldfinger, MD, FACC
We already know about some positive results that have occurred with Obamacare, including the elimination of pre-existing illness restrictions by insurance companies, allowing young people to stay on their parents’ plan and the removal of dollar caps from health insurance plans.
But besides that, at this point, we have mostly promises which include providing coverage to over 30 million people. However we know that promises don’t count—only results–because of the broken promises regarding keeping your insurance and your doctors.
The New York Times article linked below by David Lurie is inspiring, and we all welcome relief for those in need, but putting out anecdotes like this will convince only the naive that the new healthcare system will make our country healthier.
We need to wait until at least 2014 to learn how well the ACA is working in terms of the practice of medicine. I have been repeating that mantra and I will look forward to seeing documentation of success in the form of numbers and not anecdotes. If Obamacare delivers on its promises, then we all can jump on board and be happy. But if it fails, then we will need to reinvent healthcare in the US.
To Healthcare worker… Please do not blame the ACA for the issues you are seeing because of the $21B ARRA – HITech Act (EMRs and meaningful use) and the subsequent push towards the new insurance coding system called ICD 10. I am all to familiar with those issues along with some of the new ones relating to the Accountable Care Organizations. I am willing to talk offline about those things if you wish.
Carol
Paul and company … The ACA subsidies are based on gross income contrasted to the federal poverty line (FPL * 4 (or 400%) by the number of persons to be covered in a household. For 1 person, the FPL is $11,490. For 4 people, the FPL is $23,550.
The subsidy is the difference between the maximum your premium is allowed to be vs the premium the insurance companies will charge. That maximum is based at the level above the FPL your salary is. There is a premium cap of 9,5% for people who earn between 300 % to 400% of the 4 person FPL or between $70,650 and $94,200. That means the maximum premiums are between $6712 to $8949. Any cost above that is the subsidy.
Thus if a family of 4 earns $47,100 they would have an income of 200% FPL ($23,550) and under the law would have premiums capped at 6.3% of their annual income: $2967.30 Again, any cost above that is the subsidy.
So it’s not like those people are not kicking into the cost, they are kicking in at a lower cost (affordable) That doesn’t mean it doesn’t hurt for a family of 4, but it does get many of the uninsured into the pool and remember, they are usually the ones with kids. If we look at the risk pool, its been expanded by virtue of covering more younger people which is the way all insurance works.
Let me just say that one visit to the ER by an uninsured person will, at a minimum be $2000, with the average being $7000 for a day.
Respectfully,
Carol
This is from CSmonitor.com: “Is Obamacare on the rebound? Media turns to positive stories and videos.”
“…find and publicize the ACA success stories.”
and: “Part of this wave of positive stories may be a media effect: Reporters (and the public) get tired of all the wall-to-wall negativity, and, to keep interest up, seek out happy stories for a change of pace.”
Also, on a TV news show a few days ago, they reported that a media blitz would be initiated by the administration in order to increase enthusiasm for the ACA, and one of the approaches recommended by the HealthCare.Gov folks was to look for individual success stories.
CBS reports, “The campaign won’t come cheap: The total amount to be spent nationally on publicity, marketing and advertising will be at least $684 million, according to data compiled The Associated Press from federal and state sources.”
Interesting ACA “success” stories in the New York Times article.
My wife — who is a retired social worker — clued me about a process of “Medicaid estate recovery” that mandates that, “States that participate in the Medicaid program are required to enact provisions in order to recover from the estate of a deceased Medicaid recipient all monies expended on behalf of that recipient during the recipient’s lifetime.”
Mr. Acosta, the owner of the moving company in Arizona who has leukemia, is 57 years old, and so the state would be *required* to recover any Medicaid payments from his estate when he dies.
I wonder if the “counselor at a community health center, who found — to Mr. Acosta’s astonishment — that he qualified for Medicaid under the new health care law, the Affordable Care Act, which gives states the option of expanding the program to include more low-income adults” would have mentioned that detail to Mr. Acosta.
The medication used to treat his leukemia is Gleevec. The wholesale cost of an annual supply of Gleevec is more than $76,000, according to the manufacturer. I imagine that there would be some fairly large expenditures associated with his treatment that the state would attempt to recover from his estate.
And why wasn’t healthcare reinvented? The old saying goes: “Necessity is the mother of invention.” You can’t tell me the need was not obvious, so who or what didn’t let it happen/why didn’t it happen?
“We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.”
That’s Ronald Reagan speaking about Medicare (pre-passage) in 1961. Today, we have ACA opponents screaming, “Keep the goverment’s hands off my Medicare” because it’s so popular. Medicare had its problems early on. It still has problems. But it’s popular…and for the most part, it works. And that’s what many opponent of the ACA fear the most…that it will work, that it will become popular.
I can’t predict the future – nobody can. And it’s fair to speculate about what might happen, good or bad. But we’ve barely started this thing – Medicare didn’t destroy freedom like Dutch predicted. In fact, it’s done a lot of good. Who knows – perhaps that’s where the ACA will end up. Nobody says it, like Medicare, can’t be tweaked and improved over time. And if enough Americans decide they don’t like it, they can vote for a president and Congress who will end it.
And while we are on the subject of affordability of healthcare coverage, consider an article in today’s Times which points out that along with the premium cost, a consumer has to consider the added expenses of deductibles and copays. These policies may have low premiums, but the out-of-pocket expenses are often substantial, especially if the consumer does not get a subsidy. (The NY Times says, “Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium. But insurance plans with lower premiums generally have higher deductibles.” –see link below)
If an individual earns over $28,725.00 or a family of three earns over $48,825.00, then they will not qualify for a subsidy. The out-of-pocket expenses for an individual may be up to $6,350 before it is capped. For a family, the number is $12,700.00.
Until last week, the ACA website did NOT reveal the deductible costs. Only the premium costs were revealed to shoppers. So before anybody gets excited about the affordability of the ACA, all the numbers have to be added up.
And then, if enough healthy young people do not sign up, in 2014 the insurance companies will raise the prices and make the premiums less affordable.
All this stuff was in the ACA from the start, but few people actually read it, and the Obama administration purposely failed to disclose it to the American people in time for them to oppose the bill.
http://www.nytimes.com/2013/12/09/us/on-health-exchanges-premiums-may-be-low-but-other-costs-can-be-high.html
It’s affordable only for those getting subsidies from the “rich” or healthy. Even so, the ACA is already projected by the CBO to cost the federal government $710 billion over its first 10 years (see link). This program is fantastically expensive. How is it “Affordable Care”?
http://www.cbo.gov/publication/44176
For my part, I don’t think that the New York Times, which has published an ongoing series of very critical articles on the problems with the ACA roll-out, is taking orders from the “Administration” on the content of its news coverage of the program.
That said, if you have some evidence for the charge that the reporting staff of the paper is acting at the orders of the President or his staff. I suggest you forward it ASAP to the paper’s ombudsman and to its editors (and also that you make it public).
As for the impact of the ACA, I tend to give credence to deeply knowledgeable health care industry experts like Ms. Rizzo — who explained that the ACA is making health care more widely accessible and affordable to Americans (like those interviewed by the NYT reporter), even though the larger project of reducing the uniquely out-sized costs of health care in this country is still ahead of us.
Finally, I am intrigued by your comment that — if the ACA “fails, then we will need to reinvent healthcare in the US.”
It was opposition to certain wholesale changes in the system — including and especially opposition to eliminating health insurance middle-men — that largely led to the adoption of the ACA’s Romney/Gingrich/Heritage Foundation-style program.
It seems, however, that you may favor a more radical reinvention than that the President was able to get enacted. What form would you like to see that reinvented system take? And how would you propose to get it done? Thanks
David. The Administration has notified all its supporters in the media to begin publicizing anecdotes of patients that show the ACA in a good light. That is why this article appeared today, not to illustrate how bad the current system is.
As for the “undeniable fact that coverage is now affordable and available,” you are a bit premature with that conclusion since many people are finding coverage to be much more expensive with the exchanges than before and, because of the website problems, some are having trouble with availability as well.
Regarding the anticipated physician shortage, you are correct that it has to do partly with the greater availability and lowered cost of coverage for some that should increase the numbers of citizens seeking care, especially Medicaid care, but some of it has to do with the expected interference in the practice of medicine which will drive some doctors away and with the poor reimbursements by insurance companies that will encourage many doctors to refuse to participate in some ACA networks.
I can tell you as a healthcare worker that the results of the ACA are so far very disturbing and it is just the beginning.
These stories exemplify the well documented – and hardly anecdotal – problems with the current health care insurance regime.
Now as for hard numbers on the ACA, many will not be available, let alone reliability analyzed, until many months – maybe years – from now. After all, it is new.
But the fact that coverage is affordable and available to many who did not have it before, well, that is undeniable. In fact, it is why you have been arguing that there will be an MD shortage. Feel free to post this. Thanks