<p>I have no idea, calmom. This is what she told me. She is not a low information consumer. Perhaps I misunderstood her. Who knows? She said quite specifically to me that she was on Medi-Cal, is now on Medicaid and this new Covered LA program and did not mention subsidies. She also said she was frutrated because she had easier access to care before making this change. I am not sure why she would say it was switched to a different program unless she believed it had. I also cannot imagine changing to some other kind of insurance or filling out new paperwork unless she thought she had to. </p>
<p>I have no idea why doctors were changed or why she is having issues. This is someone who has been dealing with many health problems for years and she expressed to me how frustrated that her medical care has suddenly become more difficult to receive. She does not lean in one direction, politically, either. She is less partisan than just about anyone I have ever met in real life or on this board. </p>
<p>One thing that recently changed is she got married. I do not know if that changed her ability to use Medi-Cal. </p>
<p>If you really need a drug, your doctor can and will request the exception. And if it’s medically warranted, the insurance company can and will grant it. Yes, it’s an extra step. If it’s not worth the “hassle”, then perhaps you don’t understand the difference between “want” and “need.” Sort of like the difference between Cedars and the lowly “community hospitals.”</p>
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<p>Sorry, but it HAS always been this way. Five years ago, before ACA was a twinkle in the President’s eye, a woman at my work was denied a new blood pressure med. The doctor appealed to the insurance company, and the exception was granted. She got the med, because her doctor proved she needed it. This is nothing new.</p>
<p>Look, I understand your upset about all of this, I really do. For years and years, you’ve been getting Rolls Royce care at Chevy prices. Pretty sweet deal for you, which the rest of us paid for. Now you’re being told that a Chevy price is only going to get you a Chevy, or alternately, if you want a Rolls, you’ll have to pony up for it. </p>
<p>Calmom and texaspg are right. Medi-Cal is the name California uses, and has always used, for Medicaid. Your friend wouldn’t have been “moved” from Medi-Cal to Medicaid because they are the same thing. </p>
<p>Many doctors would not take Medicaid patients before ACA and probably more will refuse to see Medicaid patients in 2014, since many doctors do not want to be inundated with Medicaid people. </p>
<p>dstark mentioned that Cedar Sinai is now available to subscribers of exchange plans. It is a little more complicated than that when you are living in the eye of the storm. For instance, I essentially have two choices in the individual market: Anthem and Blue Shield. Blue Shield has a very restricted network of doctors and hospitals in my region and, therefore, is not a realistic possibility. Anthem has a wider network and seems to include Cedar Sinai (although it’s not reflected as such on their website) but the network is also fairly narrow for my region. My urologist will not accept Anthem and the website is wildly inaccurate, so it is very difficult knowing who is the network. In addition, Anthem is no longer in the Blue Card program, so you cannot elect to go to a provider outside of the state. Both companies have narrowed their formularies. In reality, both choices are flawed, hence my choice of group insurance. </p>
<p>I hope everyone on this board who is now enrolled in an exchange/off-exchange plan will not get a major illness this year. The best outcome is that you will not need the type of care which will be hard to get under this new law.</p>
GP, I do not have a clue as to what it is like in your area – but in my area, I am fine. The exact same hospitals that I would have chosen for care in the past are in my network. My personal doctor hasn’t signed up (yet) – but I’ve already found someone else in network who is accepting new patients – so I just plan to give it a couple of months to figure out whether my doctor plans to get onto the network. </p>
<p>I have other friends in the area who now have insurance through the exchange and have confirmed that the providers they want to see are indeed on network, including some who were not able to get insurance before and are overjoyed that they can get medical care. </p>
<p>A few days ago I had a friend visiting from out of state who had a semi-urgent medical need (a cut had become seriously infected) – she made an appointment with the clinic at the hospital that is in my network and was seen and treated very quickly. As she is out of state, it was not an ACA thing – though I know that she has a pre-existing condition and had insurance from her state’s high risk pool before – so I assume she has probably switched to an ACA-compliant plan – the local clinic would accept the Blue Card if that’s what she has. But my point is that it is the same hospital/ same urgent care center that I would use, on my plan, if I needed care.</p>
<p>We all understand that you weren’t happy with your options. You certainly repeat yourself enough. </p>
<p>But you don’t seem to understand that your personal experience is not universal. </p>
<p>There are multiple choices and networks with the exchange plans. People are getting care. </p>
<p>I’d also note that despite the stories about doctors who won’t take Medicaid-- I have seen my Medicaid-enrolled grandson get excellent medical care for his broken leg, with prompt appointments at the best facility in his city, at no cost to his parents. My grandson broke his leg right before planned out of state travel, and we decided to go ahead with the trip. My son was worried about medical care in our destination state (Texas) and I did some online research and found at least 3 urgent care clinics near to where we were staying that accepted Medicaid… I’m not denying that there are some geographic areas and some communities where it is a problem-- but again, it’s not universal.</p>
<p>I also hope that no one on this board gets a major illness this year – because I don’t want to get sick myself, and I certainly don’t want others to get sick. But I am happy to know that the people on this board who couldn’t get insurance because of pre-existing conditions before are able to get insurance now – and that no one has to ever worry that an illness of any kind will preclude them from getting insurance in the future. </p>
<p>Samurai, I don’t know whether your friend is confused, or whether you misunderstood something she said, but nothing in the sequence of events you reported makes sense. As we’ve pointed out, Medi-Cal is what California calls Medicaid and that hasn’t changed. You also wrote that, “Her preexisting health condition made her eligible for Medi-Cal since she was a kid - not sure exactly how that works.” – that doesn’t work. If she had a severe enough of a disability to qualify for SSI, then I think she might have qualified for Medi-Cal because of that - see <a href=“Understanding SSI - SSI and Eligibility for Other Government and State Programs”>http://www.ssa.gov/ssi/text-other-ussi.htm</a> – but that’s not the same as having a preexisting condition. </p>
<p>If your friend was married last year, than her husband’s income would be counted in determining subsidy or Medi-Cal eligibility. So that’s another possibility: perhaps she does not earn enough by herself to qualify for subsidies, but with his income counted they do.</p>
<p>I would add this: it seems that your friend has had free or low cost medical care in the past through a taxpayer funded program, and she now has free or low-cost medical care, also via a taxpayer funded program (though we aren’t sure from the info given exactly which subsidized programs they are.). It also appears that she may be transitioning into an HMO. I understand the inconvenience and frustration she is experiencing, but I know many people over the years who had employer insurance and had to deal with similar frustrations when their employers changed their policies – the shift from a PPO to an HMO can be especially frustrating, but it certainly is not something new nor something particularly tied to Obamacare. My son experienced a similar issue with employer based HMO coverage about 10 years ago — he had been assigned an HMO primary care provider near my home, but he was transferred temporarily to another city about 75 miles away for his job, and got sick with an ear infection. He could not get an appointment with a regular doctor or clinic because he wasn’t an existing patient and he was supposed to do everything via his assigned primary care provider – he finally went to an emergency room at my insistence (and with my promise to pay the HMO copayment - which at the time was about $100).</p>
<p>The use of managed care to administer Medicaid is not new – I know that my grandson in Washington gets health care via Molina, which also services some communities in California. </p>
<p>I’d note from reading the material that your friend should be able to choose among several plans, and she also is allowed to change plans if she doesn’t like the one she has. </p>
<p>You are hearing an anecdote from a person who was understandably frustrated when she needed urgent care and had to spend hours in an emergency room – but it seems like she has an excellent array of choices. </p>
<p>She has a physical disability from birth in addition to preexisting conditions. </p>
<p>She did mention that she had been part of Healthy Families. </p>
<p>I am not sure she would agree that she has an excellent array of choices in terms of getting a doctor’s appointment, but thanks for clarifying. </p>
<p>Yes, she has had free or low cost care, so it is hard to complain. Yet, being as sick as she was and being told to go to the ER and then wait so long is what she had an issue with. Previously she could go to a walk in clinic if she could not see her doctor. </p>
<p>I am sure things take time to figure out, but if you are from this area Harbor UCLA serves not only trauma cases, but also many who have no insurance. Her concern was that this was the new reality. You cannot generally plan your illnesses two to three months ahead. Same with well woman exams. </p>
<p>Anecdote. Recently, two friends in the medical field and I had a convo about enrollments and Medicaid. One: “But doctors won’t take Medicaid patients, their needs aren’t being met. I’m hearing this, I’m hearing that.” The other: “But my clients are Medicaid patients and they are not experiencing this.”</p>
<p>Another anecdote: years ago, I overheard one life insurance agent offering tips to a newbie, speaking about the value of instilling fear in prospects, how it can be done, the seeds planted, without being so direct as to be obvious. We can all stand to be a bit sensitive to fear-mongering, recognize it, and distinguish it from rational thinking.</p>
<p>Only at CC can you be called a fearmonger and irrational, all before you have even finished your morning coffee. </p>
<p>It is amazing to me how many regular posters have disappeared in this thread over the last several weeks. We should send out a search party. Hmmm. I wonder why that might be?</p>
<p>SL, there are a couple of major things that Obamacare does that I think benefit society and benefit You and Your loved ones. I think you are ignoring those benefits and they are huge. These benefits do cost money. They are not free.</p>
<p>One benefit is that health care costs depend on income so if income drops below 400 percent of poverty level you get a subsidy. If your income drops it is nice to know that your health care costs can drop too. </p>
<p>The second benefit is that preexisting conditions are no longer a factor.
100,000 people are not affected by preexisting conditions. It is way more than that.
There were three effects caused by preexisting conditions. </p>
<p>Some people with preexisting conditions couldnt get insurance. </p>
<p>Some people could buy insurance but their preexisting condition would not be covered.</p>
<p>Some people could have their preexisting condition covered but the cost would be very high to prohibitive.</p>
<p>These two benefits are game changers. 30 million more people or so are going to have insurance.</p>
<p>Then there are other benefits. There is this myth that the us older folks have all the wealth and the young don’t have much. The truth is nobody has the wealth. The wealth is tied up in very few hands.
Those of us in our 50s and 60s see that we are going to need some wealth when our careers wind down. Our wealth hopefully will carry us through until we die. We are going to spend our wealth. We can all read how people are concerned about their nest eggs and whether they will hold up. People should be concerned because old age doesnt look like inexpensive years to me.</p>
<p>So…I think capping how much the older pay is a benefit. Keeping people under age 26 in their parents plans is a benefit to the young. There is a benefit for the young. 3 million more young people have coverage now. Women no longer have to pay higher premiums than men. We no longer have annual caps or lifetime caps. I hope nobody here ever has to worry about caps but I am glad they are eliminated. The amount of bankruptcies due to health care is going to plummet.</p>
<p>There are problems with Obamacare or any other proposal. There are costs. Under Obamacare, The networks are shrinking. A person’s favorite doctor may be out of network. Some people have to pay more. Some people are going to have problems paying their deductible. Wait times may increase. Out of state coverage isnt as good as it used to be. Some people are going to fall through the cracks. Obamacare is not being implemented the way it was designed in many states. </p>
<p>Just weigh the benefits against the costs. The benefit side is heavier. </p>
<p>SL, there has been fear-mongering/scare-mongering all around us, including by the vaulted media. We can flip out or try to be rational. Not calling anyone irrational. I;ve said this a lot: I told my girls not to fall into:" I think it so it must be true." And, “I read it somewhere, so it IS true.” Applies to this thread. That’s all.</p>
<p>Geez, Bay. That’s all this thread is anymore.</p>
<p>I have a problem with the law. No, you don’t. The law is not responsible for anything bad that has recently occurred. And anyway without it millions more would have other problems.</p>
<p>Yes, Flossy, it becomes tiresome hearing others pontificate on about how great the law is, and repeating over and over about what it contains, including the basics, as if we didn’t all know.</p>
<p>Wow, I am not seeing this at all. I think it has been a fair discussion of what each person is finding and when their info conflicts I believe they are doing their best to get down to the facts…</p>
<p>Bay, I am partially responding to your posts about preexisting conditions. The preexisting condition issue is much larger than you suggest in your posts. </p>
<p>Google is your friend. ;)</p>
<p>My premiums are higher because of the benefits I wrote about. These benefits cost me money. Thousands of dollars. </p>
<p>I wrote about negatives. They exist. Thousands of dollars a year for me… Gone.</p>
<p>You arent even in the individual market, are you?</p>
There are costs. Under Obamacare, The networks are shrinking. A person’s favorite doctor may be out of network. Some people have to pay more. Some people are going to have problems paying their deductible. Wait times may increase. Out of state coverage isnt as good as it used to be. Some people are going to fall through the cracks. Obamacare is not being implemented the way it was designed in many states. </p>