Obamacare

[Lamplighter]

Originally Posted by classicman

Stormie - not sure I get your point. Are you saying that smokers are going to be surcharged under the PPACA?

A partial answer (here) is, Yes, except it is worded in the opposite direction

The rules also give employers new freedom to reward employees who participate
in workplace wellness programs intended to help them lower blood pressure,
lose weight or reduce cholesterol levels. <snip>

[classicman]

That would be incorrect Mr. Lamp.
The correct answer is NO. No one is penalized at all for anything.
Links here and the summary here are to the complete law and the summary.

[Stormieweather]

No, I'm not saying it's GOING in that direction, I am saying that smokers and obese individuals have paid more in insurance costs, already.

From 2006:
Higher Insurance Rates

If you are/were not a smoker, you may not even have noticed, but all the questionaires you fill out when you purchase insurance ask if you smoke, or have smoked, in X# years. And then, how much you smoke. And drink, and BMI, etc. If you check yes to these, your rates are higher than if you say no. It has been this way for years.

(I get to answer NO to all of them, finally!)

[orthodoc]

Originally Posted by glatt

If you have no money and no health insurance now and are having a health crisis, you go to the ER and get treated there. You can't pay the bill, so the rest of us pay for it with higher hospital prices. Under Obamacare, you will have health insurance and go to a doctor instead. Maybe even sooner, where you will get it treated for a lower cost. Gross costs will go down.

You're assuming certain behaviors (i.e. people who have health insurance will go to the doctor instead of using the ER for non-urgent problems), but many people prefer the ER for reasons I'd rather not get into. Unfortunately, costs will go down only if there's a penalty for using the ER when you could have gone to the doctor, and penalizing people for ER use is a tough political sell. More often, the hospital and/or doctors get penalized when people use the ER inappropriately. That saves money (if person A turns up five times in seven days and his/her insurance refuses to pay for more than the first visit) but results in hospitals closing ERs wherever possible.

(The disincentive in Ontario ERs is that in an urban center you'll typically wait 12+ hours or more to be seen. That's good for filtering out those who ought to go to an Urgent Care; not so good for those who are urgently/emergently sick. But I digress.)

[Happy Monkey]

Originally Posted by orthodoc

Unfortunately, costs will go down only if there's a penalty for using the ER when you could have gone to the doctor, and penalizing people for ER use is a tough political sell.

There is a penalty for doing that. It's much more expensive. What other penalty would you be talking about?

[Lamplighter]

Originally Posted by classicman

That would be incorrect Mr. Lamp.
The correct answer is NO. No one is penalized at all for anything.
Links here and the summary here are to the complete law and the summary.

I had a boss years ago that just that same strategy
(but he used the most up to date references available)

[orthodoc]

It's not more expensive (to you) if your copay is $3 and you refuse to pay it, and your premiums don't go up no matter how much you use the ER, and there's no limit on the number of ER visits you can make. You still have to be seen. But you're right, people with private insurance and hefty ER co-pays already get penalized for frivolous ER use.

[Happy Monkey]

Part of Obamacare is to get more people on private insurance.

If you don't have insurance, and you don't have money, your options may be a $1200 ER visit you can't afford, or a $300 doctor visit you can't afford. You can't afford either, so you might as well go to the one that is set up to accept walk-ins.

If you have insurance, a new option is added - a doctor visit with a $20 copay.

Not everyone will take advantage of it. The people you'd rather not get into, perhaps. But many will. Once the hurdle (sometimes mental as much as financial) of getting enrolled is overcome, it's much easier to do it.

[classicman]

I am saying that smokers and obese individuals have paid more in insurance costs, already.

OH, gotcha. Yep, I know all about that. I had poison ivy last spring, lost my job and had to buy individual insurance in the fall. I was rated because I had a "skin condition."

If you have insurance, a new option is added - a doctor visit with a $20 copay.

OR ... Dr. visit with a $20 co-pay vs ER with a $20 copay. If the copays are the same, the behavior will likely not change. However if the Dr. visit has a $20 copay and the hospital has a $100 copay, the behavior may change.
Same goes with meds. generic vs name brand where available.

Total aside, I did read an article about some doctors group advocating that birth control should be available over the counter. THAT makes a lot of sense & removes the whole religious "whatever" from that situation. Seems like a win-win idea to me.

[Happy Monkey]

ER copay is usually more, and on top of the actual ER cost, instead of in lieu of it.

[classicman]

I'm aware of that HM. With a son like mine the ER staff are not strangers, not by a long shot. Did you get the point I was making though?

[Ibby]

Originally Posted by classicman

Total aside, I did read an article about some doctors group advocating that birth control should be available over the counter. THAT makes a lot of sense & removes the whole religious "whatever" from that situation. Seems like a win-win idea to me.

The only issue is, I'm not okay with that if it means that low-income/impoverished people do not have access to birth control without paying out-of-pocket. That and the potential for accidental or uninformed misuse, without a doctor making sure the treatment is taken correctly. Birth control - like ALL medical care - should have little or no out-of-pocket cost. the only things that should cost anything at ALL, and even then maybe less than what it costs now, are things to treat mild mild mild ailments not worth seeing a doctor, like a cold or a headache or gas or indigestion.

[JBKlyde]

alls I know is that my rent went down 22 dollars about 2 weeks before he got reelected

[orthodoc]

Originally Posted by Happy Monkey

Part of Obamacare is to get more people on private insurance.

Not everyone will take advantage of it. The people you'd rather not get into, perhaps. But many will. Once the hurdle (sometimes mental as much as financial) of getting enrolled is overcome, it's much easier to do it.

Yes, many will (hopefully) take advantage of the chance to get private insurance and will behave as you expect. The mental hurdle you mention, though, is significant. The healthy 20-somethings who choose not to have insurance now, because they feel the odds of needing it are low, will resent paying premiums and copays. They aren't likely to take on that expense unless forced to, when they've been getting along without. (There are quite a few young adults in smalltown who work full-time, decline to enroll in the health insurance their employer offers because it would cost them $20/month although they choose to spend funds on smoking 2 ppd, and still expect to be seen in less than an hour at the local ER while fully intending never to pay for that service. This is very common in the smalltown area.)

Another part of Obamacare is expanding eligibility for MA. This sounds like a good thing on the surface; however, it will be a serious problem for hospitals. At the moment they can write off non-payment from self-pay patients. If the percent of MA patients they see goes up substantially they will get the MA rates (which are less than overhead for both private practices and hospitals), no copays even at $3, no writeoffs, and they'll go bankrupt. Especially when there are no limits to the number of ER visits on MA - there are individuals, and not just a few, who have 200 ER visits/year in smalltown.

Please understand, this isn't a rant at self-pay or MA patients. One of my sons is on MA and I see the system from his perspective as well as from that of a provider. But people don't always behave as you'd expect, and there are always unexpected results from programs that seem beneficial at first glance.

[glatt]

Originally Posted by orthodoc

The healthy 20-somethings who choose not to have insurance now

They are part of the problem.

This group will have no choice but to get health insurance once obamacare is completely implemented. And that's good for the system as a whole.

At first, if they don't get health care, they will look at the penalties and do the math and see that the penalty is the better deal, but the penalties get more and more severe as obamacare is phased in. And when it is fully implemented in 2018, the healthy 20 somethings will have to decide whether they want to pay an arm and a leg for nothing or an arm and a leg for healthcare.

And the policies offered at the exchanges will be subsidized based on need.