Anyone ElseTerrified about Repeal of ACA Bill
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I am very open minded and have lived all sides of the healthcare system having had my Cadillac plan for most of my life, then no insurance, then insurance but sub-standard during my dx which wiped me out financially on top of a nasty divorce, then the ACA, then Medicaid (which was amazing and everything covered 100% and with many more doctor choices), and now back into the ACA. I will share a very familiar story. Many years ago when I had my Cadillac plan I knew a young woman whose husband was disabled and she worked a part time min wage job and she had no insurance . She began having abdominal cramps but the tests were so costly that she put them off and hoped it would pass. By the time the pain was unbearable she finally needed services but at that point she was stage 4 ovarian cancer and passed within weeks of her dx at the young age in her mid 40's. I was outraged and even though I had excellent coverage I thought that should NEVER happen in this country, having to make the choice between food and expenses or healthcare. I have thought of that woman so often thru the years and ironically I find myself in a similar situation today. We all know these stories from being here on the boards and know women who felt a lump but are uninsured and have to make the hard choices.
I will only add that I have had to do much research to find hidden programs for under and uninsured women. One amazing program is called CEED and if lower income and underinsured or uninsured they will cover everything 100%, soup to nuts, but the only hitch is that they must DX you and while they would cover a new primary with someone like me, anything they did not initially dx would not be covered. And yes, all our hospitals have programs for inpatient hospital services but they cannot help with doctor fees or medications so it is not a free ride, thus why bankruptcy is rampant.
I am grateful for this forum to share, and voracious, I understand and respect your thoughts as well. All voices are welcome.
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This is an American issue; I decided it's best for me to butt out, so I've deleted this post. I will leave my input to just my previous post, where I focused on issues related to universal healthcare based on what I see happening in Canada.
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NotBrokenJustBent:
Hospitals are doing a sneaky thing now where they are keeping people for days but billing everything as outpatient. Apparently if they bill as inpatient, the insurance can reject the entire bill but if they bill as outpatient, everything is billed individually. But it raises the cost to the patient. My hospital has a ward for this. I stayed in it for nearly a week. The worst part about it was there was only one restroom in the entire ward and no shower so no way to bathe or clean myself up unless I wanted a very expensive sponge bath.
There were no windows either. I eventually got them to start the process to transfer me to an inpatient ward but my issue resolved and I was released before that happened. Then I recieved a $150,000 bill, and most of the charges were from people who just came in my room, introduced themselves as part of the whatever team, and left.
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pupmom, thank you for your insiteful post. J
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I just received the renewal letter and change to policy information on my ACA plan yesterday. To begin with, I can't find any doctors who accept it, and I am only allowed to use one (undesirable) hospital in all of the DFW area. My premium went to $788 a month. They increased the deductible to $7,350 PLUS increased the max out-of pocket to an additional $7,350. That means that If I had a little more than $30,000 medical expense in a year I would pay premiums, plus deductible, plus out of pocket of approximately $24,156 out of pocket in a year. How is this possibly affordable. I would be bankrupt even with insurance, especially if it went over across two policy years. This is an inexpensive plan compared to others slightly better - many with premiums in the $1200 to $1500 per month level.
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WC, I had that issue with doctors coming into my room after a car accident. It was a parade through my room and when I would ask them a simple question they said that they were not my doctor and did not have my chart but were just checking on me. When I got my hospital bill they had all billed my insurance. I called my insurance company and told them not to pay their bills but who knows what they decided to do, but what a scam.
Also when I was on Medicaid I never saw a bill and tried to track them down as I wanted to see an accounting. I made numerous calls but no one could help me. I asked "How do you know if there is fraud if I don't even know who is billing you"? I could never get an answer and finally gave up. They acted like I was the first person who ever asked for a printout of their bills. Ugh.
My mother is on Medicare. She would fall, we would take her to the ER and thereafter eventually they would put her upstairs in a room, but for whatever reason she was not "admitted" for a few days. Thereafter, after lying in a bed for three days she would get so weak that she needed inpatient rehab but Medicare would not cover her rehab unless she had been 'admitted' for a certain number of days, so even though it was not medically necessary, but rather an insurance and hospital glitch, we had the hospital keep her. After a week in the hospital her rehab was fully covered but by that time she was in such a weakened state that she ended up in a rehab facility for at least a month. This happened three times and geriatric specialists always say that with the elderly they decline quickly when hospitalized and not mobile, but yet these are Medicare's rules. Go figure.
This is where I would start. Can we begin by cutting out the waste, fraud, bureaucracy and incompetency?
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Melissa, that is outrageous but I suspect I am in a similar boat. I am fortunate in that I get generous subsidies but I live paycheck to paycheck and live a very frugal existence. My max out of pocket is almost 1/3 of my total income. This is insanity and yes, my choice of doctors is very pathetic and means starting all over with new doctors, the fourth time in 7 years. I am sorry you too find yourself in this sh*t fest.
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Muska, the Texas Constitution mandates that our State have a balanced budget and not run a deficit.
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Muska, thank you for speaking the truth about Texas. I'm a 5 yr resident in the Houston area. Texas is last in the number of doctors per capata. We have possibly the largest uninsured population in the nation. Texas prides itself in stripping any federal program away from its citizens. My children teach here and have junk plans through the school system just to have catastrophic covererage. Their premiums would take half their paycheck but facts never get in the way of Texas being bigger and better than the rest of the country. Jo
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Melissa, all states have that in their constitutions. Why would such a provision keep TX from accepting the Medicaid expansion? The states pay nothing for that, and their citizens get better coverage.
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It's not just Texas with the high premiums, I'm in California and we're both self-employed, our ACA premiums for 2019 will be $1875 for a silver plan, up from $1495 this year. Before ACA our premiums were just over $500 a month and they have been steadily rising ever since (so I don't blame it on the current administration). Don't get me wrong, I am extremely grateful for pre-existing coverage but I'm not sure how long we can continue to afford our health insurance when our premiums take up that much of our income. We're talking about selling our house. Last year I hit my out-of-pocket max in March and I'm dreading facing that again next year. My only saving grace is the co-pay assistance plan from Genentech. I couldn't get that co-pay assistance if I went on Medicare.
ACA subsidies cut off around $65,000 for a family of two, so imagine a husband/wife making just over that amount (not us, thankfully we make a bit more but I am no longer working), and between premiums, co-pays, deductibles, etc. more than a third of their income would be going to health care. How is anyone supposed to keep a roof over their head and food on their table, especially if they live in a state with a high cost of living (a one bedroom apartment here is $2000 month)? Calling it the Affordable Care Act is a joke.
On a somewhat related note, Pfizer and Novartis have agreed to cut the price of their breast cancer drugs Ibrance and Kisquali in the UK so they can be used in Britain's state funded health care system. The amount of the discount is confidential. Those of us in the US face nothing but dramatically increasing drug prices. Can't help but wonder if part of the reason our drug prices are so high is to offset the discounted prices in the rest of the world. My Herceptin/Perjeta is $10,000+ every 3 weeks with a 20% co-pay.
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A big part of the problem with expanding Medicaid in Texas is our huge population of people here illegally. Those people will still be uninsured plus their babies born here almost all qualify for Medicaid, WIC, food stamps, etc. A hefty chunk of my property taxes go to support our County Hospital District which also treats the uninsured.
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I don't get it: you say illegal residents do not qualify for Medicaid in Texas. If Medicaid were to be expanded in Texas to subsidize more legal residents what does it have to do with the illegal residents who would not be covered anyway because they are not legal?
Babies born here qualify for Medicaid now anyway.
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in Texas and approximately 20+ other states, illegal residents qualify for in-state tuition...LEGAL out of state residents pay out of state tuition prices. While my son was a New York resident, we paid out of state tuition prices so he could attend Universiy of Texas.....likewise, illegal residents pay in stat tuition prices at the New York State public universities....
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It is pointless to continue trying to explain how much having conservatively 1.5 million to 2.0 million poor uneducated people in our state who don't belong here costs us for medical expenses and education.
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I thought we were discussing health care, not education. Are you blaming education issues on illegals too
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Ouch!!! How much do we dislike and distant those who do so much work in our neighborhoods.
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I don't dislike anyone-it is a financial reality.
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Ohhhhh
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I've heard there is a serious shortage of people who will do low wage labor, particularly in agriculture, but also construction and other areas. This is also hurting the economy.
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After having stood in lines for Medicaid and social programs, I can tell you that it is all poor Spanish, mostly women with young children. Perhaps this is chain migration? Don't know but only relaying my personal observations from the almost three years that I was in the program.
Well we scored a win yesterday. While not necessarily affordable, at least the ACA is safe for another few years.
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Speaking as a person in a health-related field, it is not "all poor Spanish, mostly women with young children."
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It is here ksusan. The city I report to makes the list of the worst crime ridden cities in the country. Yes, all Spanish here in the Welfare office.
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I mean no disrespect to the Latino community but this what I have personally witnessed time and time again. It just is.
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Not surprising that in certain parts of the USA there would be more Spanish than English speakers seeking public assistance. That doesn't mean they shouldn't be helped.
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Not surprised at Spanish speaking and Hispanic or Latino population since much of Southwest was Mexico until the 19th century. Since the ACA will not be repealed for two years and the battle will continue to rage against humanity,this thread may be moot. The political discussion should start a new thread so as not to mislead those who are surfing threads. Just a suggestion. Jo
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Two more years brings me that much closer to Medicare. While very discouraged with the ACA rates, substandard insurance is better than none so I will try to be grateful for what I have. Heck, in one more year I can declare bankruptcy again if my bills get out of control.
If older people are draining the ACA system because we are more inclined to have health issues perhaps the option to buy into Medicare at 50 or 55 is a better alternative?
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The thing I find most distressing about our inability to fix healthcare is the human cost. Ordinary people are sick and dying.
Meanwhile, some people and companies are making record profits off our broken healthcare system.
I used to think it didn't make sense. Now I realize it does make sense if the objective is to make money, not to care for sick people.
Cynical I know, but it's true.
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I don't understand how this lawsuit affect us. Sounds like judge will rule against the provisions of the ACA. Then what? Then appeals but just when I thought we were safe for awhile.
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