<p>A FB ad from my exchange, just showed up:
Did you recently quit your six-figure job as a lawyer to become a ventriloquist?
We’re not judging. We’re just giving you a special enrollment period.</p>
<p>Emilybee: Interesting proposal. It would certainly eliminate some other problems. No more part time jobs. Period. Employers would have a much better educated and capable work force. Some who would not flip burgers or pour coffee today might just consider 40 hours a week at McD’s or Dominos if it included full health care benefits. It would certainly give employers a huge amount of leverage.</p>
<p>It might cause a problem for those who need to work part time, students and parents come to mind. College students home for the summer would be SOL. It also would seem to cause problems for the less educated or under trained. The competition for positions now considered entry level would certainly increase dramatically. I see where this might work very well for employers because if it is an across the board, no exceptions policy then it’s an across the board rise in cost of products. </p>
<p>Yes, and all doctors would have to accept Medicaid. That should cause a major drop in providers.<br>
Hmmmm…not bad… 
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<p>Emily doesn’t quite understand that health care is not everything. There would be even more poor, but with Medicaid. Sigh.</p>
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<p>So how does this work? Who decides the providers’ reimbursement? Is it the same for every provider for the same procedure, like Medicare? If it is, what is the insurance companies’ role in this scheme? If it is not the same reimbursement for every provider, why are some providers getting more than other providers, and why aren’t the lesser-paid providers asking for the same reimbursement, since they get no compensation for charging less?</p>
<p>Flossy and I don’t always agree, but in this case we do: Emily’s proposal would reduce employment, and it would particularly reduce employment among low-wage people whose health insurance costs would be a higher percentage of their potential income. The idea that employers would be required to buy insurance for their employees, but it wouldn’t count as a business expense, I find particularly ill-chosen.</p>
<p>“Emily doesn’t quite understand that health care is not everything. There would be even more poor, but with Medicaid. Sigh.” </p>
<p>Some of those working poorly paid part time jobs who now qualify for Medicaid because their income is so low would have to be made full time workers - thus earning more money and getting employer health insurance and not Medicaid anymore. Would probably be a wash in the end. Also, there is no system anywhere in the western world that doesn’t have some form of government paid health insurance for the most needy so any solution has to have a medicaid component. </p>
<p>“It might cause a problem for those who need to work part time, students and parents come to mind. College students home for the summer would be SOL. It also would seem to cause problems for the less educated or under trained. The competition for positions now considered entry level would certainly increase dramatically.”</p>
<p>Perhaps there could be some percentage (lets say 5%) of employees a company can have as part time and not have to be covered as long as that employee is covered by a spouse or parents insurance plan. </p>
<p>I don’t think it would cause problems for the less educated or under trained. There is no reason Walmart or McDonalds, or the local hardware store for example, needs anyone with a college education to be a cashier or stock person. And likely, someone who is more educated won’t stay in a job like that for long and high turnover rates is bad for a companies bottom line. </p>
<p>“So how does this work? Who decides the providers’ reimbursement? Is it the same for every provider for the same procedure, like Medicare? If it is, what is the insurance companies’ role in this scheme? If it is not the same reimbursement for every provider, why are some providers getting more than other providers, and why aren’t the lesser-paid providers asking for the same reimbursement, since they get no compensation for charging less?”</p>
<p>Nope. It would be the insurance company who decides and on plan the employer chooses. For example, my insurance plan that I have now pays X dollars for a certain procedure but my health care providers accept insurance plans that pay Y dollars for the same procedure and Z dollars from other insurance. You don’t believe that doctors are paid the same amount from every insurance they accept now, do you? </p>
<p>Every employer paying for insurance, no matter how many hours worked-- can those of you running a small business afford that? Could even a large business afford it? Someone earning 10/hour, working say 15 hours, now gets full insurance, adds to the prorated cost per hour. Is it really feasible?</p>
<p>Most likely we won’t be getting any financial analysis or data any time soon.</p>
<p><a href=“CBO throws in the towel on scoring ObamaCare | The Hill”>http://thehill.com/policy/healthcare/208314-cbo-to-stop-measuring-certain-o-care-effects</a></p>
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<p>This is not a warm and fuzzy…</p>
<p>LF: speaking as a small business owner, who hangs out with other small business owners…no it’s not feasible. That’s why I stated earlier the long reaching repercussions would be no more part time employees. Those businesses who can, will adapt to changing regulation by doing what works best for them. When regulations, mandates and requirements get to a point where the business is no longer viable…well…then it goes out of business.</p>
<p>Additionally <a href=“http://thehill.com/policy/healthcare/overnights/208321-overnight-healthcare-data-errors-found-in-2m-o-care-sign-ups”>http://thehill.com/policy/healthcare/overnights/208321-overnight-healthcare-data-errors-found-in-2m-o-care-sign-ups</a></p>
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<p>So the part of the system which is least sustainable, the patients providers can not afford to see (see note above about what happens when a business can’t sustain itself) is the part of the system expanding rapidly. And, it is a source of pride and gives a sense of success and accomplishment.
Yea!!! we are selling more of the thing which is running at a loss. whooo haaa… It makes my brain hurt.</p>
<p>And every time you move a part-timer to full-time status, there goes one PT slot. It would be nice if employers could safety-net everyone, but as you said earlier, dietz, you’re already increasing your prices to cover costs. Thus it costs me more to buy your product. Sometimes, deep pockets is better in theory than practice.</p>
<p>And now these low-paid workers would have healthcare, but can they pay the rent? </p>
<p>D- do we know docs really can’t afford to see Medicaid folks? </p>
<p>emilybee, I’m sorry. Could you explain this again? I don’t get it. Let’s say I run Fang Insurance. I know that every provider has to accept my plans, because that is the law. What is to prevent me from saying, I pay $1 for every procedure, and you, Dr. Feelgood, and you, Forest Resort Hospital and Casino, have to accept that as payment for a heart transplant, because that’s the law?</p>
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<p>Full time workers, or no time workers.</p>
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And I agree with you sometimes, Fang - for a fix short of gutting, an unemployment rate in the high-teens would be an especially suicidal one for those enacting it.</p>
<p>Would be a complete reversal of the employment number inflator that the ACA is as currently written, though.</p>
<p>LF: from my previous post</p>
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<p>This is one example. You can play with this…take one of your recent CPT codes listed on an EOB. Take a look at what your insurance reimbursed the provider and then check to see what Medicaid would have reimbursed. It’s shocking how big the difference. A practice can afford to cost shift from the insured to the Medicaid only so much. Taking in an additional volume of Medicaid patients only makes things worse. So, IMO practitioners really can not afford to take Medicaid. It’s not that they would lost profit…it would actually cost them real $$.</p>
<p>“Every employer paying for insurance, no matter how many hours worked-- can those of you running a small business afford that? Could even a large business afford it? Someone earning 10/hour, working say 15 hours, now gets full insurance, adds to the prorated cost per hour. Is it really feasible?”</p>
<p>If they can’t figure it out how to make a profit and still cover their employees health insurance then they go out of business. Too bad for them. Those that can will stay in business and succeed - picking up business from those who can’t figure out how to pay for their employees benefits. </p>
<p>I have no sympathy for the business community. They had their chance to lobby for a system which would have decoupled health insurance from employment and they chose not to do so. </p>
<p>New Jersey pays a doctor $23.50 for an office visit with a Medicaid patient. But a doctor in Wyoming is paid from $67 to $95.57 depending on the complexity of the patient’s ailment. Pennsylvania’s doctor office visit rates range from $40 to $54.42. In New York, it’s $37.41 to $56.18. Across the nation, basic office visit rates range from $20.64 to $111.22, according to the Kaiser Family Foundation.</p>
<p>Dietz, I’m not one pushing a whole hog Medicaid solution (actually haven’t considered it much.) I’d like to see very low cost walk-ins, low overhead, for all sorts of routine work, follow-up, and first diagnosis. When I lived in CA, (ages ago,) the ones I knew had a high number of retired docs with PT schedules. We could offer something like loan forgiveness for young, new docs to commit for a few years. My question was do we know what docs really “need” to pull in, to cover costs? And how much is fluff? There’s a reason medicine is one of the highest paid professions, generally. When I had looked, the advice from medical practice advisors was for total costs (staff, equipment, procedures, contact, etc) to run under 60% of revenue. Doesn’t that imply a lot of profit?</p>
<p>How many docs have what proportion of their patients on Medicaid? </p>
<p>“I have no sympathy for the business community.”</p>
<p>As someone who benefits from a public employee insurance plan and pension, I am not surprised.</p>
<p>“If they can’t figure it out how to make a profit and still cover their employees health insurance then they go out of business. Too bad for them.”<br>
^^^^
…says the person who has never run a business. When these companies go out of business or shift their employees to Obamacare taxpayers will pick up the cost.</p>
<p>LF: I like the idea of walk in clinics. Most likely a number of potentially bigger problems could be diagnosed and treated while it’s a level 1 issue - instead of level 10. Doc’s could work a number of either pro-bono or very reduced fee hours. And, yes, it would be a great way to work off those student loans. The clinics could be State run.</p>
<p>As for the Medicaid portion of a practice…somewhere in the way deep recesses of my brain I remember reading it was a 4/1 ratio. 4 full pays for 1 medicaid pay. The differences in the State compensation amounts is interesting. I’d guess those states with the least Medicaid patients can afford to give the highest reimbursement. </p>
<p>We have an Oncologist in the family. They are a big supporter of the ACA (well, they were 3 years ago - haven’t really broached the subject in a while). This person has had their salary cut over the years due to overhead and increasing costs. I think the image of the golf playing, Lexus driving overpaid physician relates to a very small and specialized subset. Probably those that the regular peon can’t even access.</p>
<p>And Emily: As those loathsome business go under and while you are cheering their demise keep an eye on the lost tax revenue. It will have to come from somewhere. They are coming after government pensions in my area…and ‘they’ are winning (look into San Jose). So careful about the cavalier ‘let them eat cake’ attitude. You may be the recipient of just such a cake in your lifetime.</p>
<p>Emilybee, I’m sorry. Could you explain this again? I don’t get it. Let’s say I run Fang Insurance. I know that every provider has to accept my plans, because that is the law. What is to prevent me from saying, I pay $1 for every procedure, and you, Dr. Feelgood, and you, Forest Resort Hospital and Casino, have to accept that as payment for a heart transplant, because that’s the law?</p>
<pre><code>Some of those working poorly paid part time jobs who now qualify for Medicaid because their income is so low would have to be made full time workers
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<p>I did and when I went to post it said I didn’t have permission!!! </p>
<p>80% of premiums have to go towards covering claims - so if Fang Insurance thinks it can make enough of a profit by only paying $1 per procedure - I say go for it and good luck. </p>
<p>“Full time workers, or no time workers.”</p>
<p>A person who is able to work full time at Company A can give up the part time job at Company B that they needed to have to make ends meets - allowing a part time worker at Company B to become a full time worker at Company B and able to give up the part time job they needed at Company C to make ends meet and so on and so on. Businesses still need to have coverage for all the hours they are open for business - unless they reduce the hours they are open. </p>
<p>Will some people lose there jobs, probably. But company’s shed workers for all sorts of reasons. </p>
<p>CF: weird alliances call for a round of coffee…(or Merlot - it’s getting late) I’ll buy :)</p>