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<p>Nothing? <em>coughMedicaidExpansioncough</em></p>
<p>Cardinal Fang, :).</p>
<p>“Hospital Corporation of America, the biggest for-profit hospital network in the country, reported a 6.6 percent decrease in uninsured patients across its 165 hospitals, according to Bloomberg. And in the four states where HCA operates that expanded Medicaid, the drop was 48 percent.”</p>
<p>The public is still getting gouged. We have to do more on price transparency. We are moving in that direction…very slowly. </p>
<p>We are playing Whack a Mole a little bit.</p>
<p>CF: have you been following the problems with Medicaid reimbursement rates? How doc’s don’t want to take patients with this coverage because it doesn’t cover the doc’s costs. </p>
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<p>GREAT argument for getting more people insured, which is exactly what ACA has done. 12 million more insured people now, IIRC.</p>
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<p>Yes I have, but you were talking about care providers who have to treat patients who can’t pay, and care providers who then have to shift costs to paying customers. The only care providers who are obligated to provide care to people regardless of the ability to pay are hospital emergency rooms. Hospitals take Medicaid. </p>
<p>So if indigent people can get Medicaid, then they are not going to show up in emergency rooms with no way to pay. Rather, they will have Medicaid, and hospitals will be reimbursed by Medicaid for their care. So they won’t have unreimbursed care to pay for by shifting costs to other paying customers.</p>
<p>That is exactly what is happening in Medicaid expansion states. Hospitals are finding that their unreimbursed care costs are plummeting. Of course they are-- because if a Medicaid eligible person shows up at the hospital, the hospital will sign them up for Medicaid on the spot. </p>
<p>In anticipation that states would expand Medicaid, and unreimbursed costs would decrease (as indeed they have in expansion states) the ACA cut payments to hospitals for unreimbursed care. This is a disaster for hospitals in non-expansion states: they still have indigent people arriving, getting care and being unable to pay for it, but the US government is not paying them as much for that care.</p>
<p>Reality is that Medicaid pays little enough there’s a ton of docs that won’t take it - splitting hairs isn’t going to change that, and neither is Texas joining the list of the over-mortgaged. </p>
<p>Changing the terms of the cost-shifting didn’t require upending the whole system, as has been pointed out enough. A simple check in the mail to the uninsured would have ideally have accomplished the exact same thing as the subsidy. Gotta admit that rigging it where it couldn’t be spent at a convenience store showed a little foresight but, lord at the hoops everyone else has had to jump through.</p>
<p>“it needs to be bought, stored, tracked and inventoried. It needs to be administered by someone who is pulling in a very good salary. It needs to be monitored by that individual.”</p>
<p>Right, but that’s where the $1100/night room charge is supposed to go. It was a really nice hospital room, but it was way less nice than my $139/night room at the Omni. Most of the difference has got to be for the nursing service. The room should include nurses even if they don’t dispense overpriced saline. Which I didn’t need, and which I eventually succeeded in refusing. I was taking water (and tea and Diet Coke) by mouth just fine.</p>
<p>I also had to fight to avoid being given pain medicine, because I knew there would be some ridiculous upcharge. They forbade me to take the Advil in my purse, so I refused their $20 generic ibuprofen, waited until they left the room, and took my own Advil. (I’m just guessing that theirs was $20; it might have been more.)</p>
<p>Some of this has nothing to do with hospitals’ having to serve the uninsured. Some of it is just plain old captive pricing. Why is a bottle of water $8 inside the stadium when they’re 10 for $5 outside? Because they can. This is the exact same crap.</p>
<p>Thanks for posting that article, Hanna. That’s the one I wrote about in the post above yours, but forgot to include the link to the article. (Too early, coffee hadn’t kicked in yet!)</p>
<p>I’m wondering if all patients get charged the extra fees. Say, for example, Medicaid patients. If Medicaid won’t pay, do they even bother to charge those patients the fees? So are the private insurance patients not just paying more for their insurance (and the insurance is paying for covered services at a higher rate), but also paying for things the others aren’t even being charged for? </p>
<p>A year in:</p>
<p><a href=“Is the Affordable Care Act Working? - The New York Times”>Is the Affordable Care Act Working? - The New York Times;
<p>Also, some personal stories:</p>
<p><a href=“A Perfect Fit for Some, but Not Others - The New York Times”>http://www.nytimes.com/interactive/2014/10/27/us/affordable-care-act-personal-stories.html</a></p>
<p>For want of a better place to post this, I am putting it here. It relates to some of billing stuff by hospitals, sort of. </p>
<p>As many of you know, I had significant medical bills late last year and earlier this year. One of the bills was for lab work - which I was charged $283 for and which my insurance co denied coverage. I called them immediately (last February) and it was determined that it was billed incorrectly as out-of network and the total that I really owed was $9.45. My insurance company said they would take care of it. I assumed I would receive a new bill from the hospital. </p>
<p>On Friday, I got a Notice of Debt Collection from a local law firm in the amount of $9.45. </p>
<p>I am quite familiar with how providers and insurance can mess things up so I diligently save every bill, every EOB, and record on bill the date I paid, the check #, and the amount. So, I pull out all the bills and EOB and there is nothing, except the EOB with my notes that my ins. is going to cover it all except for the $9.45. I even went through all my check registers, on the oft chance I didn’t save the bill. Again, nothing. </p>
<p>Of course it was too late to call the hospital billing so I had to wait until this morning. </p>
<p>I called the hosp. billing department and explain in detail. She informs me that they have been sending bills monthly since February. I say I have never received one - though I received all the other bills from the hospital. Not wanting to fight over a measly $9.45 - which I know from the info my ins. gave me that it was what I would owe as a co-pay, I asked to just pay it. She says she will have to transfer me to customer service. Ok. Then, of course, I wait on hold for the next 30 minutes. Sigh. When I finally get through I repeat the story and tell customer service I just want to pay the amount owed and he tells me, sorry, I have to call the number on the notice and pay. Now, I am really aggravated, since the billing dept said I could pay through customer service. So, he asks me for the account number on the notice. Then he pulls up my account and looks at it and the amount I owe and he tells me I was never billed because a mistake in their computer program was kicking out any bill under $10 - and that they are working on fixing the problem. I should just wait for a new bill to pay. I said it would be nice if they would give that information to the billing dept so others who call don’t have to go through all the rigamarole I needed to. Then I told him it I better not get dinged on my credit report for their mistake. He assured me I won’t, but I have my doubts. </p>
<p>I think the non payment of bills after a specific time must automatically go from the hospital billling department to the law firm and some program spits out the Notices of Debt Collection. </p>
<p>Document that call, about bills under $10 not going out.</p>
<p>I personally believe the idea behind Obamacare is fundamentally sound, however the ACA itself is inherently flawed. As opposed to dispersing the funding for the program more reasonably, it becomes a burden only to those who are law -abiding. ER visits that generally are covered and must be attended to do not need to be paid if victim is poor. Therefore the burden falls primarily to the middle class to provide a tax backbone for the entire program.</p>
<p>PS Please Chance me for colleges I’m desparate
<a href=“http://talk.collegeconfidential.com/what-my-chances/1700196-help-2-7-gpa-32-act-chances-of-getting-into-any-good-colleges.html#latest”>http://talk.collegeconfidential.com/what-my-chances/1700196-help-2-7-gpa-32-act-chances-of-getting-into-any-good-colleges.html#latest</a></p>
<p>Oh I did. I also got the guy’s name who gave me the info and the date & time I called. </p>
<p>Who was helped the most by ACA:</p>
<p><a href=“Obama’s Health Law: Who Was Helped Most - The New York Times”>Obama’s Health Law: Who Was Helped Most - The New York Times;
<p><a href=“Some doctors wary of taking insurance exchange patients”>http://www.usatoday.com/story/news/nation/2014/10/27/insurers-aca-exchange-plans-lower-reimbursements-doctors/17747839/</a></p>
<p>Low reimbursement rates and the 90 grace period (the time after the person has not paid the premiums but still has insurance but the insurer will not pay the doctor) are the reasons why over 200,000 doctors say they will not accept the ACA policies. (The figure comes from another article, It’s roughly 1/4 of doctors).</p>
<p>Colorado’s rates hold very steady for 2015 – overall .71% increase in the individual market. Depending on the region, rates changed max down of 7.44%, and max up of 5.26%. My area held close to zero.
<a href=“http://www.coloradohealthinstitute.org/uploads/downloads/2015_Rate_Analysis_Report_2.pdf”>http://www.coloradohealthinstitute.org/uploads/downloads/2015_Rate_Analysis_Report_2.pdf</a></p>
<p>Two new insurers entering the market, and nobody leaving. An insurance co-op appears to be having some significant pricing effect; we’ll probably look at that once the marketplace opens on 11/15. </p>
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<p>But is it in fact the case that 1/4 of doctors are taking no ACA policies? Do we have cites on this?</p>
<p>Last week I had the opportunity to speak with a Covered CA spokesman. He basically says the consumer needs to verify the network issue because the lists are inevitably inaccurate by the time they are printed. That’s assuming they were ever accurate, of course.</p>
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<p>And, as we’ve heard here, it turns out it’s impossible to verify the networks in a lot of cases.I don’t get why this state of affairs is allowed to continue. Why isn’t it a truth in advertising issue? Why are insurers allowed to represent that they deliver a certain product (doctors, hospitals) when they don’t?</p>
<p>Well…the insurers are being sued.</p>