Affordable Care Act (AKA Obamacare)

[Socnorb11]

Even if you can afford the insurance, many people can't afford the deductibles. Hospitals are taking a huge hit because of this. Hospital systems that used to make a few hundred million per year profit, that they would invest in replacing old equipment and expanding their systems, now are just hoping to break even in just a couple years. It won't be long before smaller hospitals go under, and even the bigger ones think about merging to get through this.

I'm not following this. Prior to mandatory health care, who paid the deductibles for these people that are now not paying the deductible?

[Socnorb11]

Well, this guy is a diabetes educator, or something like that and this site is obviously geared towards diabetics, but the examples he gave were copays that were roughly half of out of pocket costs (plus deductibles, plus premiums), only poor quality gear/medicine being covered, stuff not being covered or being covered in a way that isn't really beneficial. Diabetes has a lot of options available and there are many different ways to treat it, and that's just for Type 1.

For instance, some people are on a straight two shots a day regimen. They're forced to eat at the same time and the same amount, roughly, every day. They use two different types of insulin, combine them, and take a shot in the morning and do the same thing at night. Then, there are people who use different types of insulin and take one in the morning and take the other one every time they eat. Then there are people who use a 'pump' that delivers a continuous (roughly speaking) supply of only one type of insulin. There are many different types of pumps and 'gear' like tubing, catheters, etc. Obviously, some are better than others. Pumps, unsurprisingly, are expensive. Maybe $5k or so.

Then, there are blood glucose meters. These use test strips. The going rate for some of these test strips, which cost a quarter of a penny to produce, can be up to $1/strip. Some are closer to $0.20/strip. You kind of get what you pay for. Apparently a lot of insurance plans will only pay for the cheaper strips. Further, there are continuous glucose monitors (CGM). These, like pumps, have gear that keep the meter constantly in touch with the patient and give a blood glucose reading all the time. Also, like pumps, they are expensive.

So.....sorry for the tangent. All that to say this and more to his point: Sure, you can get 'covered' via a plan on the exchange. But, if you're paying $2500/year in premiums, and the plan is going to force you to pay a $1k deductible, $100 copays, and then half if not more of stuff like pumps/CGMS, well, what good is it? The cost of treatment is more expensive than people can afford. At best, they receive marginal discounts on prescription refills but lose that margin when the premiums are factored in. So, they're better off just paying the penalty (about one months worth of premium) and staying uninsured.

I presume this is all in reference to the lower end plans, fwiw, since they can't afford the more expensive plans.

Who was paying for all of that stuff before the ACA? I mean all of that stuff is REALLY expensive (as you pointed out). Are you saying that the premiums plus the copays plus the deductible amounts to more than diabetes care would cost without insurance?

[AWvsCBsteeeerike3]

Who was paying for all of that stuff before the ACA? I mean all of that stuff is REALLY expensive (as you pointed out). Are you saying that the premiums plus the copays plus the deductible amounts to more than diabetes care would cost without insurance?

Well, no one. But, that's the thing. There are, from what I understand, cheaper insulins/treatments available. Without insurance, you can buy insulin at WalMart for $25/vial. You'll need a couple different vials. And, you'll probably go through a few vials a month. Let's say $75-$100/month for insulin. Then there's test strips. That's probably possible at another $50/month. All in all, let's just say you could, without insurance, get by with $150/month for prescriptions. It's possible to stay alive and in control for that, again, from what I understand.

Premiums are going to be more than that. And then there are the deductibles and the copays. The thing with insurance is it should help offset the costs of more expensive treatment....or at least make it in the realm of affordibility. But...if you're making $30ishK, paying $2500 in premiums, $1K in deductibles, probably another $1k in copays (if they go with a more expensive insulin), that doesn't leave much room to go buy even a half priced pump at $2500 or CGM at $2500. Hell, it is an expenditure of $4500/year for what used to be $1800ish.

Edited to say: In the end, it's still the budget that's deciding what treatments people will receive, not what they actually need....which is a fail in my opinion.

[Secret Weapon]

Even if you can afford the insurance, many people can't afford the deductibles. Hospitals are taking a huge hit because of this. Hospital systems that used to make a few hundred million per year profit, that they would invest in replacing old equipment and expanding their systems, now are just hoping to break even in just a couple years. It won't be long before smaller hospitals go under, and even the bigger ones think about merging to get through this.

I'm not following this. Prior to mandatory health care, who paid the deductibles for these people that are now not paying the deductible?

Prior to mandatory health care, the government reimbursed hospitals for providing uncompensated charity. Now that everyone is supposed to have insurance, the government has taken away these compensations yet the patients with insurance aren't able to pay their deductibles, so the hospitals are taking a big hit. There are also a lot more people going to the ER, and then not being able to pay for that either.

[Joe Shlabotnik]

Even if you can afford the insurance, many people can't afford the deductibles. Hospitals are taking a huge hit because of this. Hospital systems that used to make a few hundred million per year profit, that they would invest in replacing old equipment and expanding their systems, now are just hoping to break even in just a couple years. It won't be long before smaller hospitals go under, and even the bigger ones think about merging to get through this.

IMO, the quicker we get rid of for-profit hospitals, the better. Give it back to the nuns and the do-gooders who used to run hospitals as a public service. I'd much rather be at a place that did not see my misfortune as a profit center. And I think the quality of care would be better as well.

[Socnorb11]

Even if you can afford the insurance, many people can't afford the deductibles. Hospitals are taking a huge hit because of this. Hospital systems that used to make a few hundred million per year profit, that they would invest in replacing old equipment and expanding their systems, now are just hoping to break even in just a couple years. It won't be long before smaller hospitals go under, and even the bigger ones think about merging to get through this.

I'm not following this. Prior to mandatory health care, who paid the deductibles for these people that are now not paying the deductible?

Prior to mandatory health care, the government reimbursed hospitals for providing uncompensated charity. Now that everyone is supposed to have insurance, the government has taken away these compensations yet the patients with insurance aren't able to pay their deductibles, so the hospitals are taking a big hit. There are also a lot more people going to the ER, and then not being able to pay for that either.

So your point is that the lack of government subsidies are hurting hospitals?

I'm not necessarily saying that's a good thing or a bad thing.......... but if hospitals can't survive without government subsidies, then our health care system is a wreck to begin with. I'm not saying that the ACA is the entire answer, but you surely have to admit that the status quo as you present it can't sustain (or at least shouldn't sustain) long-term.

[Socnorb11]

Who was paying for all of that stuff before the ACA? I mean all of that stuff is REALLY expensive (as you pointed out). Are you saying that the premiums plus the copays plus the deductible amounts to more than diabetes care would cost without insurance?

Well, no one. But, that's the thing. There are, from what I understand, cheaper insulins/treatments available. Without insurance, you can buy insulin at WalMart for $25/vial. You'll need a couple different vials. And, you'll probably go through a few vials a month. Let's say $75-$100/month for insulin. Then there's test strips. That's probably possible at another $50/month. All in all, let's just say you could, without insurance, get by with $150/month for prescriptions. It's possible to stay alive and in control for that, again, from what I understand.

Premiums are going to be more than that. And then there are the deductibles and the copays. The thing with insurance is it should help offset the costs of more expensive treatment....or at least make it in the realm of affordibility. But...if you're making $30ishK, paying $2500 in premiums, $1K in deductibles, probably another $1k in copays (if they go with a more expensive insulin), that doesn't leave much room to go buy even a half priced pump at $2500 or CGM at $2500. Hell, it is an expenditure of $4500/year for what used to be $1800ish.

Edited to say: In the end, it's still the budget that's deciding what treatments people will receive, not what they actually need....which is a fail in my opinion.

I think that's a good explanation, AW........ it's just hard for me to follow because I'm so unfamiliar with diabetes.

Still, this scenario seems like both a best case and worst case, at the same time.

It's a best-case scenario, because you're assuming that diabetes is and always will be the only medical issue that this person has to deal with. I mean, if this person has diabetes AND breaks an arm (or some other major medical expense), then they'll probably be happy that they had insurance.

It's a worst-case scenario also, because it sounds like there are a lot of unusual circumstances (pumps and such) that come into play when we're talking about diabetes.

[Socnorb11]

Secret Weapon, according to this article, hospitals enjoyed record profits in 2012:

http://www.modernhealthcare.com/article ... /301099961


Granted, there are lots of ways to view these statistics.............. but it looks like they should have some wiggle-room, overall.

[Secret Weapon]

ObamaCare Deductibles Hit Patient Pocketbooks And Hospital Finances

http://www.forbes.com/sites/brucejapsen ... -finances/

“The increasing shift to high deductible health plans meaningfully impacted patient volumes in 2013,” said Jim LeBuhn, senior director and sector head at Fitch Ratings, which said in a report this week that such plans and “rising consumerism” would negatively impact hospital financial ratings. “We expect the growing popularity of these plans to further challenge utilization rates going forward.”

Locally, Mercy just had a round of layoffs for exactly the reasons I listed...

Mercy Health, the sixth-largest Catholic health care system in the U.S., last week announced plans to lay off approximately 200 to 300 employees across its network of hospitals and clinics in Kansas, Arkansas, Missouri and Oklahoma. The company attributed the layoffs, which will go into effect at the end of June, in part to the refusal by some states to expand Medicaid eligibility as authorized by the Affordable Care Act.

Other considerations, including lower rates of inpatient service use and reimbursement reductions, also led to the Kansas-based nonprofit’s decision to cut back the number of jobs in support services.

“Like all health care providers, Mercy is managing the impact of market changes, including reimbursement reductions from government and commercial payers, lack of Medicaid expansion in most of the states we serve and declining inpatient utilization,” Mercy Health spokeswoman Barb Meyer said in a statement on Wednesday. “We have been expecting and preparing for these changes for several years and have made tremendous progress in redesigning the health delivery system to meet evolving needs.”

[Socnorb11]

That sounds like a state issue, Secret Weapon.