LocalGrowGuy
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The major issue with the ACA is the removal of medical underwriting. This means that insurance companies have to allow everyone in the front door. Healthy individuals used to enjoy lower insurance rates that mirrored their low utilization. Unhealthy individuals had to pay more. A valid argument is that some folks don't choose to be unhealthy, so why should they get penalized for being sick or having certain health conditions? The answer is: they shouldn't be penalized. Thus, no underwriting, which creates adverse risk and removes the ability to pool claims. Like employer sponsored health plans, they also do not have medical underwriting, but they break even because the rate of participation is significantly higher that in the private sector. If insurance companies can't deny coverage, then everyone has to carry said coverage, or else it won't work and we end up with this bullshit, the opposite of what is needed. I think it's important to note that our healthcare system is incredibly complex, and it's foolish to think that true reform could come via legislation. I don't claim to have the answer.
The only way the ACA can possibly be a viable option is if everyone has coverage. Everyone won't have coverage, it's obvious reading this thread that the industry is in turmoil and that a sizeable portion of our country's population will choose to go without insurance. Again, the ACA solved the access issue, but does nothing to address cost. The problem is that solving the problem of high costs is that it affects every part of the healthcare delivery system, and is laughably implausible to reform every component with a single bill. Tort reform, defensive medicine, malpractice insurance, low reimbursements, none of this can be resolved through legislation, in my opinion.
A comparison can be made if we look at your (anyone) auto insurance. How often do you use your auto insurance? Everyone is required to carry insurance and there are monetary penalties for going without. One reason why auto insurance rates are more controlled is because the risk is spread over a wide footprint. The same can't be said for health insurance.
I agree with you GG.
Do you know who decides what Medicare pays?
This is over a year old but still valid: http://www.kevinmd.com/blog/2015/01/medicaid-payment-rates-going-theres-nothing-doctors-can.html - I will note that this is from a provider standpoint.
"Medicaid is a federal program for the very poor implemented by grants to states, which do the administration. Medicaid typically pays doctors about 60 percent of what Medicare pays. In Florida, a typical primary care visit might pay the doctor $32. In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the doctor has to maintain 24 hour office availability and use EMR.
Under federal law, Medicaid rates must be “sufficient to enlist enough providers” so that beneficiaries have at least as much access to care as the general population in their geographic area (the equal access requirement). Whatever that means. But the Obama administration told the Supreme Court that health care providers had no legal right to enforce the equal access requirement in court. This section of the Medicaid law provides guidance to federal and state officials in setting Medicaid rates, but does not allow health care providers to sue state officials to enforce it. This was in response to the latest attempt to sue the government to enforce this law, Armstrong v. Exceptional Child Center, Inc. (The Exceptional Child Center, in Idaho, provides residential rehab for children with disabilities.)
As most of you know, the ACA expanded Medicaid coverage, or at least offered expanded Medicaid coverage, to the states. 9.7 million people have been added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one-fifth of Americans are now covered by Medicaid. So, in order to entice physicians and nurse practitioners to accept all these new, often complicated patients, the government hiked up the reimbursement rates for Medicaid patients.
For the last two years, the federal government has required state Medicaid agencies to pay at least as much as Medicare pays for primary care services. But only for two years. In 2015, the reimbursement rates go back to 2012 levels. $2.60 per patient per month, in the case of Alabama. A rate that providers can’t challenge in federal court.
Where’s the clause that says doctors get to have equal access to enough money to feed their children?"
[emphasis mine]
This is what pisses people off. Those poor fucking doctors, how will they make their mercedes payment? Unfortunately the ACA will cause a shortage of primary care docs, as they have to same problems with student loan debt that others do, and malpractice insurance is ridiculously expensive for lots of reasons. Why would a young person want to go to school to be a doctor, knowing the costs associated with that education, as well as the expense of running a practice in this climate?
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