Affordable Care Act (AKA Obamacare)

[pioneer98]

[IMADreamer]

Bet that quote doesn't get any play on conservative radio.

[Joe Shlabotnik]

Maryland does away with fee-for-service hospitals. Quality of care rises, costs go down and hospitals like it.

The plan hinged on ending fee-for-service payments to hospitals and moving to something called global budgeting. Instead of being paid per admission, hospitals would get a set amount of money for the entire year for patient care, regardless of how many MRI tests, ER visits or hip replacements there were.

At the end of the year, if there was money left over, the hospitals could keep it.

"Whereas before, hospitals could really only make money by keeping their beds filled, now they can actually do better if their community is healthier and they're preventing admissions," Sharfstein says.

The state tested the approach in 10 rural hospitals.

Those hospitals had to think in a new way about how to serve people outside their wards and ERs. The hospitals hired care coordinators to check with patients after they were discharged to make sure they were taking their medications and eating right, for example.

Some hospitals created primary care centers in their communities, so patients had an easier way to see a doctor instead of making repeated trips to the emergency room. The hospitals also looked to partner with community groups working on issues as basic as housing.

The pilot worked, and in January 2014, after 18 months of negotiations between Maryland and the federal authorities, global budgeting went statewide.

It was voluntary for hospitals, but within six months every hospital in the state had signed up.

Now, nearly two years into the five-year agreement, the Centers for Medicare and Medicaid Services says that hospitals are well on track to hit targets. Under the deal, Maryland has to save $330 million for Medicare over five years and reduce hospital readmission rates all while improving the overall health of residents.

[Freed Roger]

Maryland does away with fee-for-service hospitals. Quality of care rises, costs go down and hospitals like it.

The plan hinged on ending fee-for-service payments to hospitals and moving to something called global budgeting. Instead of being paid per admission, hospitals would get a set amount of money for the entire year for patient care, regardless of how many MRI tests, ER visits or hip replacements there were.

At the end of the year, if there was money left over, the hospitals could keep it.

"Whereas before, hospitals could really only make money by keeping their beds filled, now they can actually do better if their community is healthier and they're preventing admissions," Sharfstein says.

The state tested the approach in 10 rural hospitals.

Those hospitals had to think in a new way about how to serve people outside their wards and ERs. The hospitals hired care coordinators to check with patients after they were discharged to make sure they were taking their medications and eating right, for example.

Some hospitals created primary care centers in their communities, so patients had an easier way to see a doctor instead of making repeated trips to the emergency room. The hospitals also looked to partner with community groups working on issues as basic as housing.

The pilot worked, and in January 2014, after 18 months of negotiations between Maryland and the federal authorities, global budgeting went statewide.

It was voluntary for hospitals, but within six months every hospital in the state had signed up.

Now, nearly two years into the five-year agreement, the Centers for Medicare and Medicaid Services says that hospitals are well on track to hit targets. Under the deal, Maryland has to save $330 million for Medicare over five years and reduce hospital readmission rates all while improving the overall health of residents.

That is good news we can use.

[stlouie_lipp]

For 2016 my monthly premiums are increasing by $75/month and my network is getting smaller.

[jim]

Mine went down. We have open enrollment now where we can switch our benefits around, and we have this new fancy system that stores all of our stuff. I was sure I was seeing something wrong, or using it wrong, or something .. because I've never seen them go down. Apparently for most people where I work they did go down. About $40 a month.

[Jocephus]

im paying ~30 a month

[jim]

You *pay* 30 a month? Holy [expletive]. Mine went DOWN 40, and I'm still paying $449/month. My employer pays $1411/month. That's the middle plan - there is a cheaper HMO plan and then there is the blue ribbon plan. This is a family plan. My dental I pay $64/month, my employer pays $83. I don't have a vision plan.

I just looked at the entire cost - I pay $589 for health, dental, about 400k of life insurance, disability insurance etc... and my employer is paying $1515. That's a big [expletive] chunk of change.

[Swirls]

im paying ~30 a month

I have an HDHP through my company and thankfully am healthy enough that I rarely ever go see a doctor. In the event I do have a major injury or something that requires a gigantic medical bill, I have enough in my HSA to cover my max out-of-pocket for the year. My premiums are like $6/paycheck.

However, with my new job, I'm not sure what the new rates will be. I know they offer an HDHP, so the premiums should be pretty similar - I think in New York they were like $10/paycheck.

My parents haven't been so lucky - my dad owns his own small business, just two employees - him and my mom. For the past several years, they get a notice every fall saying their healthcare provider is terminating their plan because they can't afford to stay in business offering health insurance anymore. So they keep changing insurance providers every year - large companies like United HealthCare can stay in business with Obamacare, but the tiny mom & pop type agencies can't stay afloat. Unfortunately for private healthcare insurance, those mom & pop agencies are the only ones with somewhat reasonable prices. I think my parents said right now their premiums are something like $250/month each for an HDHP.

[Fat_Bulldog]

That is horrible jim.