<p>[Emergency</a> Department Visits Down For First Time Since Health Reform, Survey Finds | CommonHealth](<a href=“http://commonhealth.wbur.org/2012/01/report-emergency-department-visits-down-for-first-time-since-health-reform]Emergency”>http://commonhealth.wbur.org/2012/01/report-emergency-department-visits-down-for-first-time-since-health-reform)</p>
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<p>I kind of wonder how long this will continue, though, because if you have health insurance, the ER is usually not a good place to get health care. You have to wait forever and fill out a lot of forms. (Says the woman who went to the ER to get a strep test. Shut up. I know. But when I went into a random clinic we came across, they wouldn’t do the simple 5-minute test even if I paid them in cash.)</p>
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<p>In my state, Ohio, smokers are most certainly charged more, and if they qualify for subsidies those are only applied to the non-smoker premium.</p>
<p>The fast food comment is well taken. Where does this end? Monthly weigh-ins and drug/tobacco tests and “do you work so hard that your stress is too high” tests and verifying that you exercised 30 minutes a day 3x a week or what?</p>
<p>emilybee,</p>
<p>Here is a competing report that shows ER visits up in 2013 by 6% [Mass</a>. Sees Increase in Emergency Room Visits, Nurses Assoc. Wants to Limit Patient Numbers | WAMC](<a href=“http://wamc.org/post/mass-sees-increase-emergency-room-visits-nurses-assoc-wants-limit-patient-numbers]Mass”>http://wamc.org/post/mass-sees-increase-emergency-room-visits-nurses-assoc-wants-limit-patient-numbers)</p>
<p>I don’t know how reliable either reports are, as they appear to based on limited phone polls and other limitations.</p>
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<p>If MA is any indication, it will go on for seven years or more.</p>
<p>So smokers in Ohio don’t get the subsidy? Good.</p>
<p>I’d read that they weren’t charging smokers more because that would make older smokers pay more than three times what younger people pay and that a computer function wouldn’t allow it.</p>
<p>“If MA is any indication, it will go on for seven years or more.”</p>
<p>We have a huge ship to turn around. It’s going to take a long time, but please try not to forget that health care costs have been rising steadily for years now with no end in sight and nothing, before ACA, to bring them down at all. </p>
<p>It’s like people have completely forgotten their health insurance premiums, and if they had copays, have been going up for years.</p>
<p>From your link, Bay:</p>
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<p>Thing is, surveying people to find out how many of them went to the emergency room in the last year won’t tell us whether emergency department use is up or down. That poll simply does not provide that data. In order to know whether ER use is up, we need to know the number of visits, and not the number of people who say they have gone to the ER. If you want to know about ER visits, you just ask the hospital. They surely have that data at their fingertips.</p>
<p>No wonder ER costs are high - when my son went in due to a mental illness episode, the doctor (a young resident) started ordering tests such as EKGs! What the heck?? Then the kid was going to RELEASE DS, when he was obviously in no condition to be let out. This was in a decent hospital, too. At least we had a modest copay for the ER.</p>
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<p>This. The obvious answer has been in front of our faces all along – Medicare for all, plus optional private supplemental. It will still be there when we decide that ACA is unworkable. Hopefully we will have learned our lesson by then.</p>
<p>Smokers get the subsidy but only for the non-smoker premium amount. Every plan has two prices, one for smokers and one for non-smokers. This is through the federal exchange as Ohio opted not to set up their own.</p>
<p>Let’s be nice to the moderators, and remember to keep our comments to what is true about health care in the US now, what will be true under the ACA, and what experiences we’ve been having looking at the exchanges for ourselves and other people we know. Let’s not talk about what other plan we wish was adopted instead of the ACA; that would be a thread in itself, but not one allowed on CC.</p>
<p>On Emergency Room visits: The plans all have copays, and the copay for an emergency room visit are significantly higher than for a regular doctor visit or an urgent care center visit. So, for example, looking at the California exchange silver plans, the copay breakdown is $45 primary care visit, $90 urgent care visit, $250 emergency room.</p>
<p>So what is Cardinal Fang going to do for that sore throat if she has a choice of paying $90 or $250? (Sorry CF – you’ve brought up that example about 3 times now – I am noticing more urgent care centers being established in my community. I’m assuming that you were feeling too ill to wait around a week until you could schedule an appointment with your regular MD).</p>
<p>Even a family who is just a hair over the Medicaid eligibility level and qualifies for maximum subsidies would pay $25 for an emergency room visit vs. $6 for urgent care. </p>
<p>So I think the message will get across pretty clearly-- probably in a way that is more significant as a psychological motivator for most people. (I mean there’s pie-in-the-sky, I can’t afford any of this so I’ll just go to the nearest place and think about costs later that sets in when you don’t have insurance or don’t know what things cost. The copays are very concrete and spelled out in very clear way)</p>
<p>Ditto cf. this is an interesting and informative thread.</p>
<p>I was on a bike trip out of state, and about to go off into a pretty unpopulated area for a few days. I was feeling too crappy to ride the ten extra miles each way (after fifty miles already, with fifty extra pounds of stuff on the bike) to get to the urgent care center, and we were running out of daylight. I suppose I should have called a taxi and gone off to the urgent care, and had my friend wait with the bikes, but I didn’t think of it.</p>
<p>Post #567:
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<p>Washmother, the tax forms aren’t available yet, but I think it’s a pretty good bet that the line numbers will change. ;)</p>
<p>Here’s what I think will probably happen: The exchange will send you a special form that is like a 1098T (the forms the colleges send to report tuition and financial aid), only it will be for health insurance. Let’s call it a 1098-PPACA.</p>
<p>That form will include the following information:</p>
<ol>
<li>The metal level of the plan that the taxpayer has (so for me, I expect it will say Bronze HSA)</li>
<li>The state and region where the plan is based (me: California Region 8)</li>
<li>The monthly and annual premium level for the 2nd lowest silver plan, which is the one that is keyed to subsidy eligibility. (My region: $788 mo/ $9,456 yearly)</li>
<li>The monthly and annual premium for the plan the taxpayer is actually on (for example, I might pick the plan that is $611/month, $7332)</li>
<li> The number of months the taxpayer was insured during the year. </li>
<li>The total amount of advance premium tax credits the taxpayer received. </li>
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<p>I am guessing that there will also be a worksheet or form to attach to our tax returns which we will use to calculate our MAGI and reconcile it with the numbers we have on our form 1098-PPACA. Maybe the same form can also be used to calculate the tax penalty for people who didn’t have insurance. </p>
<p>Then there will probably be 1-3 lines on the back page of the 1040 where the numbers from the form/worksheet will be attached – there will be a line for any penalty you owe or any tax credit you are entitled to, and a place to subtract out any advanced tax credit you have already received. </p>
<p>So lets say that you get $2400 in the advance tax credit during the year, but your MAGI is higher than anticipated and you were only entitled to $1400. The math will show that you owe an additional $1000 in tax, and that show up in the “amount you owe” line at the bottom of the form. But let’s say hypothetically that you over-withheld during the year, and there is an overpayment of $1200. So ordinarily you would have that coming back to you as a refund, but in this hypothetical the overpayment of the advance tax credit is subtracted out, and your IRS refund is reduced to $200. </p>
<p>I’d personally really like to see the MAGI calculation form because I’ve heard stuff all over the map on that and it’s been hard to get straight answers. But I have a feeling that those forms aren’t going to be available until late next year. </p>
<p>Any CPA’s or tax professionals reading this thread? What kind of advance look at new forms is typical?</p>
<p>It would be due in 2015 right if there is a penalty? If so, IRS won’t be in a hurry to release it now.</p>
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Well then you’d have to factor in the cost of a taxi. If you have the full copay to worry about, then $30 for the taxi might make sense – if you are a low-income person looking at the difference between $6 and $25, maybe the taxi wipes out the savings. </p>
<p>Of course I don’t mean to give you a bad time, you did what you needed to do. The real key is to have a lot of urgent care centers, particularly in heavily populated urban and suburban areas. That’s where I went 26 years ago when I felt like I was traveling in New Zealand and seemed deathly ill with pneumonia on a Sunday morning – there was a clinic in downtown Auckland with several poor Maori families and their barefoot children in the waiting room, where I was seen quite promptly on arrival. The pharmacy with the amoxicillin was right next door and I think the whole thing would have been free if I had been a Kiwi, but being a visiting American I got a bill for $45 NZ (which included both the original and followup visit in the doctor’s private office several days later.) </p>
<p>That’s when I personally fell in love with nationalized health. There is no way on earth that I could have been seen that quickly or paid so little in the US, and that was way back when health cares costs were a lot cheaper than they are now.</p>
<p>Texas - yes, the tax would be due in 2015. The penalty is the amount you would pay if you don’t have insurance. If you received a subsidy beyond what you are due, then it’s more of a negative credit than a penalty – I’m seeing it called a “clawback”. It’s important in my mind to distinguish between “penalty” and “clawback” because of how these may be treated down the line if you don’t make timely payment. The ACA limits the type of collection efforts that can be made for the not-having-insurance penalty. I think the clawback will just end up being more tax that you owe — but there will be NO interest or penalties against that until the tax is due on April 15th. </p>
<p>In other words, I can (and did) truthfully report my income for 2012 as being around $40K. Let’s say that I make $48K in 2014, above the subsidy level. The most economically smart thing for me to do is to take the maximum subsidy for my income level in 2014 (let’s say $5000), even if I know I will have to pay it back later, because the IRS is then giving me an interest free loan. But of course that will leave me with a big tax bill I won’t feel happy about paying in 2015, so I probably won’t do that. Most people prefer to set themselves up to receive refunds-- and I probably will factor in the amount of money I have to pay in quarterlies when I try to figure out what is best for me and my budget.</p>
<p>I don’t mind that you give me a bad time. Thinking back, I don’t think I did the right thing and I should have handled the situation better. And since I will continue to do bike trips and might get sick again, I should have a plan. Though “heavily populated urban and suburban areas” are not where bike tourists usually go; I was in a rural area.</p>
<p>It’s worth realizing, though, that getting health care is a lot easier if you have a car. And lots of people don’t have cars. I was sick, so I rode twenty more miles to get to a little city, and then I was faced with stopping at the hospital, riding another ten miles, calling a taxi or hitchhiking. None of those alternatives sounded great to me.</p>