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How has the Affordable Care Act (ACA/Obamacare) affected you?


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Without getting too political, please. I'd love to hear how the ACA has affected you as a PA. Do you see more patients that wouldn't have had coverage otherwise? Or are there a ton of hoops you now have to jump through that make your life miserable? Have you not even noticed a difference?

 

I'd love to hear any and all takes on it! Please let me know what your work situation is like and how long you've been there.

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I was able for the first time in my career to work part time and locums.  Unthinkable before the ACA thanks to the one phrase that future generations will look back and ridicule us for..."Denied for Pre-existing conditions".  

Thanks to the ACA my family, myself and my patients do not worry about pre-existing conditions anymore when applying for insurance.  For anyone who has not lived through life with pre-existing conditions or practiced under its scourge, let me just tell you...it was awful and killed countless Americans.

 

If *ANY* younger (or older) providers have not watched Dr. Linda Peeno's testimony to congress, I would ask...even beg you to watch this.

 

 Her voice cracks several times as she struggles not to break down.  It is the truth of how insurance companies straight out kill people, straight from the person who stamped DENIED for three of them.  Their claim review medical director.

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13 hours ago, Cideous said:

I was able for the first time in my career to work part time and locums.  Unthinkable before the ACA thanks to the one phrase that future generations will look back and ridicule us for..."Denied for Pre-existing conditions".  

Thanks to the ACA my family, myself and my patients do not worry about pre-existing conditions anymore when applying for insurance.  For anyone who has not lived through life with pre-existing conditions or practiced under its scourge, let me just tell you...it was awful and killed countless Americans.

 

If *ANY* younger (or older) providers have not watched Dr. Linda Peeno's testimony to congress, I would ask...even beg you to watch this.

 

 Her voice cracks several times as she struggles not to break down.  It is the truth of how insurance companies straight out kill people, straight from the person who stamped DENIED for three of them.  Their claim review medical director.

Do you mind elaborating a bit more? I'm not quite following how the ACA lead to your being able to work less. Do you get your health care through the marketplace instead of your employer now, which wasn't previous possible due to a pre-existing condition?

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Go back pre-2014 in the salary and contracts forum and read what qualified as a “good offer” back then versus what qualifies as a “good offer” now. There was a sizable jump in pay since the ACA went into effect because there were suddenly millions of patients who had previously been outside of the system without a similar increase in the number of physicians available to treat them. 

 

 

So, as a recent 2017 grad who had very inexpensive ACA healthcare during school, I’d say the way it benefitted me most was making more PA jobs than there are PAs to fill them, making me worth a bundle more as a new grad than I would have been under the old system. I’d wager it is represented directly in the 10% I contribute to my retirement every paycheck. 

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My patient population was screwed by this. RHC, 3rd poorest county in the state and etc...I had 100's of patients premiums ("obamacare") double or triple. Even my MAs BCBS obamacare triple and she should be the letter. She makes $9.50/hr and works 72hrs per 2 weeks so she ain't making much, but her insurance went from $51/month to $155/month with obamacare...As for coverage I have had more patients with insurance, but lots of them were not happy with it... 

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I work in a rural clinic that sees nothing but Medicaid patients. Most of my patients got their insurance when there was the ACA expansion in my state. The ACA has been a huge blessing to the people I serve. I think I have just about the best job one could ask for and none of this would have happened without the ACA.
 

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3 hours ago, MidwesternTexan said:

OP, Why are you baiting this?

 

Are you doing research for a paper or something? 

No baiting whatsoever, you'll notice I asked people to please keep their political views out of this.

I am in fact doing this for a class assignment. I'm interested in how such a large piece of legislation actually plays out in the real world -- in particular with how it has affected PAs.

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3 hours ago, camoman1234 said:

My patient population was screwed by this. RHC, 3rd poorest county in the state and etc...I had 100's of patients premiums ("obamacare") double or triple. Even my MAs BCBS obamacare triple and she should be the letter. She makes $9.50/hr and works 72hrs per 2 weeks so she ain't making much, but her insurance went from $51/month to $155/month with obamacare...As for coverage I have had more patients with insurance, but lots of them were not happy with it... 

Where were your patients/MA getting their insurance before the ACA?
As a follow-up, are you in a medicaid expansion state?

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6 hours ago, GB2017 said:

Do you mind elaborating a bit more? I'm not quite following how the ACA lead to your being able to work less. Do you get your health care through the marketplace instead of your employer now, which wasn't previous possible due to a pre-existing condition?

 

Absolutley.  

Before the ACA everyone had to just buy insurance on the open market, which was nightmarish.  The last time I did it, I spent almost 3 hours on the phone with an underwriter taking a history so detailed about me, wife and family that it would of put any first year medical/PA student to shame.  Everything I had ever been seen for, even things I had not been seen for.  "Have you ever had abdominal discomfort and not been seen?  Questions like that.  Why?  Because they were building a case to deny a future claim based on "pre-existing conditions".  Again, watch Dr. Peeno's video about.  She goes into great painful detail about how deceitful insurance companies are.

Also, in Texas, you could NOT buy maternity on the open market after 2001.  Let me repeat that....NO private insurance company sold maternity care.  None....nadda....zip.  My last child was born in 2001 and during my wife's pregnancy we received a letter saying our insurance company was discontinuing all maternity care in Texas.  Thankfully because she was already pregnant we were covered.  After that we looked for another open market company and there was none.  Not one.  Nice eh?

Sooo, I could never consider anything but employer based income and a full-time job because of pre-existing conditions...who doesn't have a few after 40?...I would never qualify pre-ACA.  Because those scumbags now can't ask me about pre-existing conditions, I can get insurance on the open market, which I do.  This lets me work part-time and not be TIED to any one employer.  This was unthinkable before the ACA.

 

Also, to the person above saying their $9.50/hr MA's ins has gone up a lot, I have one question.  Are you in a red state that did not take the medicaid expansion? My bet is yes.  My advice?  Complain to your Governor.

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23 hours ago, MidwesternTexan said:

You just graduated, and you're already comparing salaries?

My salary/hourly really didn't change at all- as a result of the ACA.

I make over twice as much as when I graduated.  Probably about the time you were born.

The ACA?  Isn't that being de-funded?  ?

No..... I’m looking at salaries prior to ACA and after ACA using the contract subforum with its 20 pages of contracts and comments. 

 

Thank you for your anecdotal experience of not seeing a change in salary. You go back eight years and offers for new grads were considered good in the upper 70’s. Now such an offer is considered unacceptable or borderline insulting barring some extenuating circumstances. Salaries for new grades haven’t increased buy 20% in under a decade because of inflation or good will. They incresased because the number of patients have increased while the number of physicians has stayed flat or dropped in the same time frame. 

 

If you’ve only doubled your salary since 1981 you need to find a better job... and the exchanges haven’t been defunded. The only substantial change is that the individual mandate has been removed by the same party that spent a decade and a half championing the individual mandate as the “market based, personal responsibility answer to our healthcare issues”

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23 hours ago, camoman1234 said:

My patient population was screwed by this. RHC, 3rd poorest county in the state and etc...I had 100's of patients premiums ("obamacare") double or triple. Even my MAs BCBS obamacare triple and she should be the letter. She makes $9.50/hr and works 72hrs per 2 weeks so she ain't making much, but her insurance went from $51/month to $155/month with obamacare...As for coverage I have had more patients with insurance, but lots of them were not happy with it... 

A lot of that was a result of concerted efforts to undermine the ACA by preventing funding payouts in the first few years to insurance companies while actuary tables were being made. It was one of the few ways the congress could manage to attempt to stop the ACA prior to the tax bill last year. 

 

 

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20 hours ago, GB2017 said:

No baiting whatsoever, you'll notice I asked people to please keep their political views out of this.

I am in fact doing this for a class assignment. I'm interested in how such a large piece of legislation actually plays out in the real world -- in particular with how it has affected PAs.

Did you in fact disclose that when you asked the group your question? ? ?

 

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It has not changed my employment or salary in any way. What I saw in my area was people who previously couldn't afford health care so had no coverage forced to buy plans that costs about $1200/month that they couldn't afford with the promise they might get some of it back at tax time. These plans had high deductibles so the already strapped people were now paying for a plan they couldn't afford that had deductibles that might as well have been a million dollars. It created a significant burden for them.

Medicaid is pretty common around here so I personally didn't see the effects of any expansion but I'm in Texas and we had some push and pull with the feds about Medicaid. My recollection is we didn't take the money offered because we wanted to control our own Medicaid program as much as possible. That is an off the cuff recollection so your mileage may vary.

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50 minutes ago, sas5814 said:

It has not changed my employment or salary in any way. What I saw in my area was people who previously couldn't afford health care so had no coverage forced to buy plans that costs about $1200/month that they couldn't afford with the promise they might get some of it back at tax time. These plans had high deductibles so the already strapped people were now paying for a plan they couldn't afford that had deductibles that might as well have been a million dollars. It created a significant burden for them.

Medicaid is pretty common around here so I personally didn't see the effects of any expansion but I'm in Texas and we had some push and pull with the feds about Medicaid. My recollection is we didn't take the money offered because we wanted to control our own Medicaid program as much as possible. That is an off the cuff recollection so your mileage may vary.

WI, with it's Republican Governor and majorities- DIDN'T take that money either!  Much better for the citizens to have more control at the state level.  Which is doing very well, with low unemployment btw

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10 hours ago, sas5814 said:

It has not changed my employment or salary in any way. What I saw in my area was people who previously couldn't afford health care so had no coverage forced to buy plans that costs about $1200/month that they couldn't afford with the promise they might get some of it back at tax time. These plans had high deductibles so the already strapped people were now paying for a plan they couldn't afford that had deductibles that might as well have been a million dollars. It created a significant burden for them.

Medicaid is pretty common around here so I personally didn't see the effects of any expansion but I'm in Texas and we had some push and pull with the feds about Medicaid. My recollection is we didn't take the money offered because we wanted to control our own Medicaid program as much as possible. That is an off the cuff recollection so your mileage may vary.

Texas indeed did not expand Medicaid...and we have this dubious distinction....

The Texas Medical Association:

"Texas is the uninsured capital of the United States. More than 4.3 million Texans - including 623,000 children - lack health insurance. Texas' uninsurance rates, 1.75 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts."

https://www.texmed.org/uninsured_in_texas/

 

Go us.............

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The bulk of those I see are covered under the Indian Health Service and Medicaid or Medicare very very few with private private insurance coverage. My wife's insurance through her workplace(" a Cadillac Plan") increased in costs (premiums & deductibles , medication copays) with the ACA for just the two of us. Examples, excision of a SQ cyst in 2014 cost us $.00, while the same procedure in 2016 at the same facility by the same surgeon cost us $1,000.00. I suspect those whose income is less than ours took some serious hits!

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Prior to the ACA I had a decent plan with BCBS NC as a 20 something y/o male with no history for $200/mo. 2k deductibles, run of the mill co pays, PPO. My mom on the other hand who has T2 diabetes and after getting her weight under control not even irregular glucose readings anymore (and no other health issues), was quoted somewhere around $2k/mo (so wasn't insured). I did get the chance to cash in on it when I broke my leg, but by the time it was all said and done it still cost me about $7k out of pocket. Now I still pay $200/mo but have a $7k deductible (funny coincidence I know), no co pays, and HMO. But my mom pays about $800/mo for decent coverage (the details I'm not up on). So my deductible went up and on the once a year PC/misc specialist visit I pay $150, but she is saving $1,200/mo (= my whole deductible every 5 months). Just a couple more years before Medicare kicks in, that'll be nice. 

Also I've had 2 bouts of "gastroenteritis." Prior to the ACA it cost me $500 (my ED deductible), after the ACA $1k (still part of the 7k deductible), total billed was about the same in both cases. All for 1 hour in the ED, 2 bags of normal saline, and some zofran. 

If you ask me, insurance companies are only part of the problem; the 8 screws in my leg, at $200 dollars each, whose pilot holes were drilled with two drill bits, $400 each, to attach a metal plate $400 (x2 b/c the first one didn't fit), the $300 tourniquet on my leg, the two plastic staple guns at $120, each, etc etc ad nauseam is perhaps a greater contributing factor. All of that, x-rayed, hand inspected by someone getting paid $50/hr, and sterilized, should be less than $200 (I've worked in manufacturing on the management side, this is a reasonable number, double it if you want, doesn't matter). Tort reform and capping resale prices for medical equipment would probably take a huge bite out of it. National single payer is the inevitable future, the only questions is how long are we going to throw a temper tantrum for before the economic reality becomes too much to fend off. 

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Having owned my own clinic and spoken with many of the local doc's (whom are selling the the hospital system)

 

There has been a HUGE shift in practice ownership.

 

remember ACA also had a lot of the pay for performance, PQRS and the like....

 

these have pretty much killed the private practice locally.  (Just look a the 'facility fee' the hospital charges once they buy a practice and the patients get seen in the exact same office, with the same providers and the same staff = more money in their pockets)

 

This means that the local private independent physician is essentially dead, mine included......

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1 hour ago, ventana said:

these have pretty much killed the private practice locally. 

THIS....and the additional government cost (ie: tax money)....is the real story.

Want to get costs and quality under control then you should be increasing competition, not killing it.  When you only have one hospital system to go to, who also owns/runs every specialty clinic (including FP/Peds) in town, then you (and your insurer) will pay what they charge.

There will always be individual winners and losers, but with the ACA the entire country loses.

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1 hour ago, ventana said:

Having owned my own clinic and spoken with many of the local doc's (whom are selling the the hospital system)

There has been a HUGE shift in practice ownership.

remember ACA also had a lot of the pay for performance, PQRS and the like....

these have pretty much killed the private practice locally.  (Just look a the 'facility fee' the hospital charges once they buy a practice and the patients get seen in the exact same office, with the same providers and the same staff = more money in their pockets)

This means that the local private independent physician is essentially dead, mine included......

I'm not sure how the ACA would have increased, much less instigated hospitals buying out private practices. Could you elaborate?

I've see the same phenomenon but since the late 90's, and it is usually older practices whose partners basically got tired of doing paperwork and chasing insurance companies, so they let the hospital take care of all the managerial things they don't like for them. I've never heard of anyone doing it because of "financial hardship," much less incurred after implementation of the ACA. But that has been my of course anecdotal experience.

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5 minutes ago, Anachronist said:

I'm not sure how the ACA would have increased, much less instigated hospitals buying out private practices. Could you elaborate?

It's the amount of bureaucracy/regulations/rules involved.  Small practices can no longer afford all of the "compliance officers" required to ensure they capture enough billing, or don't get penalized, etc.

Look at it inversely.  How many chiropractic or naturopathic offices do you see being run by one quack and a couple of receptionists?  Lots....because they accept cash and are virtually unregulated.  No reports to the government or insurance companies.

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2 minutes ago, Boatswain2PA said:

It's the amount of bureaucracy/regulations/rules involved.  Small practices can no longer afford all of the "compliance officers" required to ensure they capture enough billing, or don't get penalized, etc.

Ahh yes, I see. Ya know my dad (an MD) wrote a letter to Ronald Reagan about how much of a problem that was becoming in the mid 1980s, along with how many extra procedures were being ordered solely as CYA, he never did heard back. He (my dad) retired in the late 90's, said if he had to start again then he wouldn't, "bureaucrats had ruined medicine."

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