I have had the same insurance from the date I married H, in 1986. In HI, even if you have the insurance that they like the best (which I do have thanks to my H’s former employer, the fed govt), it can still take many, many months to be seen by a specialist. I and my D were trying to see doctors. We called in December and the soonest we could be seen was March & April! D is a continuing patient at that specialty clinic and I was specially referred which is the only reason I will be seen at all, since the specialist is NOT accepting new patients. I do not have insurance on the ACA and never have. Nearly all doctors in my state and most of the US take my insurance and consider it “good coverage.”
Until the past 15 months, I had never had this much trouble getting in to see a specialist in a timely manner. I am fortunate that my medical issues were not urgent and that I did have physicians that would and did see me for urgent needs because waiting when I was having an infection would land me in the hospital and likely cause permanent lung damage.
I’m extremely concerned about the growing aging population in our state and shrinking number of physicians and other medical providers in our state. Telehealth has its benefits but also its limitations. The problem is even more acute in the neighbor islands and the south pacific islands. Our primary medical insurer in the state has very low reimbursement rates that are barely above Medicare reimbursements and the other insurers are lower.
These problems that are facing us were talked about in medical conferences I attended in 2007 and are still being talked about. Not many solutions were proposed then and few have been implemented. Many of the students educated at the UH Medical School leave because they have more lucrative opportunities elsewhere and cost of living and housing is lower elsewhere.
I was referred to a rheumatologist 15+ years ago. Way before ACA. Had to wait about 3-4 months. I’m still with that practice and it’s still hard to get appointments. They are just very very busy. Lots of specialists are.
The penalty for not getting coverage as part of the ACA went to the federal government.
The 30% surcharge for premium prices for not having “continuous” coverage as part of this new plan goes directly to the insurance companies! And that 30% will be higher than the $675 or so charge from the ACA.
Hospitals agreed to accept lower payments for Medicare patients - something that will cost them $350 billion dollars over 10 years - as part of the ACA. To the hospitals, it was acceptable because with the individual mandate, they would be seeing far less uninsured patients in their ERs and otherwise as patients.
Now, there is no individual mandate and no increase in Medicare payments to hospitals. Do you think they will protest this? Oh, I think they will!
Can anyone explain the pre-existing coverage surcharge for NOT being covered for some period of time? do we know what period of time that is likely to be? The concern for us : if our medically fragile kid should lose their job, or change jobs, does that make them “uncovered” and vulernable to jacked-up coverage costs?
As for wait times - it can be very frustrating. My H had to wait 3 months for one specialist and he is a physician and the specialist is at the same hospital! We are not using the ACA but like all Americans we are operating in small networks where we are covered and so that decreases our choices.
I understand the penalty being a higher insurance rate. Those who dropped coverage are picking up coverage when they are sicker. They tried to game the system. Gaming the system hurts the insurance companies by making them pay for people who haven’t paid in.
But I am not happy with this supposed fix to the ACA. There needs to be incentives built in for healthy lifestyles. At a minimum make premiums cheaper for those who don’t smoke and don’t drink.
Other than universal coverage which is what I think we need as a country, my proposal is that our federal lawmakers - you know, those ELECTED officials who are supposed to serve their constituents! - should be subject to utilizing whatever healthcare option they come up with for the rest of us.
Could be hard to enforce unless you want to be subject to drug testing in exchange for such a discount. (Probably the people who complain about the “nanny state” will be the most vocal ones against such a thing.)
One of the biggest changes in the new plan is putting caps on Medicaid. About half the people who got insurance through the ACA got it because of the Medicaid expansion. 60% of nursing home patients are covered by Medicaid, and they are the most expensive Medicaid patients. So, what happens when a state meets its cap? Will the states stop covering the elderly under Medicaid?
@greenwitch, from the bit I read you cannot be without coverage for more then two months or you will be subject to the 30% surcharge on your premium. I also read a few weeks ago that they are going to require much more proof of job loss etc to get it outside the open enrollment period. Also, the open enrollment period I read is going to be much shorter - maybe only 4 weeks. I have no idea if those proposals made it into this bill as their is more things they want to change but cannot in just a reconciliation bill…
At least I’ve never had to wait to see a doctor, even a specialist for more than a few days. Maybe there’s an abundance of doctors in my corner of the country.
Did anyone mention the elimination of all Federal funding to Planned Parenthood? That goes for birth control, cancer screening, HIV screening, std testing, etc.
Keep in mind this is a first draft and may go through various changes before becoming law.
So you want universal coverage, guaranteed and controlled by the government… the same government that is comprised of the crooked elected officials you call out here?
The docs we are seeing in March and April that we calendared in December are in DC. I’m a bit surprised at how long the wait was but we’ve scheduled our travel around the dates we were able to get. Both of the places we are going are used to people traveling to be seen by specialists. I’ve been traveling to see specialists since 2000. It’s tiring and expensive, but the care I get is better than what I am able to get in my home state. Our kids have also been traveling for medical care, since 2002 because they can’t get the care they need locally. Of course, none of the travel is reimbursed unless you are on Medicaid.
Wow–that’s significant to eliminate all federal funding for Planned Parenthood. I hadn’t heard that and it will affect a LOT of people if it ever becomes law. They provide a lot of care to a lot of people, including folks who don’t have a lot of other nearby options.
Not only is Planned Parenthood not allowed to receive government benefits (and they don’t receive federal $$ for abortions since 1976) but people using the federal tax credit can not use it for any plan that provides abortion coverage. I’m not sure what the details are but I doubt that there is any part of men’s healthcare that is prohibited.
