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

[GetMeOuttaThisMess]

9 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.

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.

Same with dental practices.  Minimal staffing, most preferred specialists don't exist on PPO plans but will work with you on being an out-of-network provider.  Shoot, my periodontist who is a former employer to my wife, gave me a 5% break for cash up front via check only earlier this week for extractions of #31 and a gratis #1 that was partially erupted and placing an implant/graft for an upcoming crown.  Cost OOP up front?  $3786.  Crown in a couple of months with resection of tissue over implant will be about $1200.  This is all for just ONE tooth (excluding the comp #1 extraction)!  How many medical practices could realistically function on a cash up front basis and WE'RE less expensive?

[PAMEDIC]

1 hour 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.
 

 

3 hours ago, ventana said:

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

 

We're managing well. We have two clinics. The one that sees nothing but medicaid patients has much less overhead and is actually more profitable than the one that is open to all the local plans and Medicare.

[GB2017]

Thank you all so much for your insight! I appreciate your attempts to take the politics out of a potentially weighty subject to help me with this.

One last thing -- could I get a "roll call" of sorts as to who is in a medicaid expansion state and who isn't??

From your comments, it seems that it's a benefit in expansion states and a hindrance in those that chose not to expand, but I wan't to make sure I'm understanding this correctly.

 

Thank you again!

[EMEDPA]

For the first time in my career I do not have employer-provided medical insurance for myself and my family. ACA allowed us to purchase coverage at a reasonable cost that covered pre-existing conditions for those in my family who have them. 

[Marinejiujitsu]

With ACA and the expansion of Medi-Cal I have seen an increase in ER visits 15%. I also looked up admissions from the ER and it also went up like 10% in california. Horrible for the cost of healthcare, it would be better if more primary care providers accepted it.

Plus side. I am seeing ER PAs in california now making 95-150/per hour but this makes me think if one law can dramatically change our pay and quality of life, I am one law away from not being able to afford my mortgage.

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[Endeavor]

Kinda off topic, but this was literally an Essay based question at a PA school I interviewed at. It makes sense to know how new insurance laws work, how it affects it's citizens, and how it affects our profession!

[UGoLong]

In a Medicaid expansion state: more patients now on Medicaid. Glad they can now afford care. Does the overhead of it need to be worked on? Yes. Would it be better to have more people without care? No.

[katieo]

1 hour ago, OneDayPA-C said:

Kinda off topic, but this was literally an Essay based question at a PA school I interviewed at. It makes sense to know how new insurance laws work, how it affects it's citizens, and how it affects our profession!

I was thinking the same thing but aren’t we not supposed to talk about the questions ?☠️?

[katieo]

2 hours ago, Marinejiujitsu said:

With ACA and the expansion of Medi-Cal I have seen an increase in ER visits 15%. I also looked up admissions from the ER and it also went up like 10% in california. Horrible for the cost of healthcare, it would be better if more primary care providers accepted it.

Plus side. I am seeing ER PAs in california now making 95-150/per hour but this makes me think if one law can dramatically change our pay and quality of life, I am one law away from not being able to afford my mortgage.

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If you’re in California, Kaiser accepts it, and they are very accessible (maybe depending on what part of CA). I have no problem getting same day primary care appointments. A lot of ER visits can be avoided with accessible primary care. 

I understand statistics > anecdote. I haven’t looked at the data myself. In my measly anecdotal experience, when I didn’t have insurance and therefore didn’t have a primary care, I used the ER a lot more (multiple visits/yr -> 0 visits/yr).

If it’s true that ER visits have increased, I’m curious to see if they might come down as patients grow their relationships with PCPs. When a patient hasn’t had medical care for a long time, it may take some time   for a new PCP to fully address all their health issues (considering time constraints per appointment on PCPs). 

[rev ronin]

I have never worked in a practice that accepted medicaid on anything other than an exception basis (0 of 4).

[sas5814]

One of my oft used expressions is it's always about whose ox is getting gored. If you have no insurance and need health care and it suddenly become available at something approaching a reasonable cost (or its "free"...don't get me started) you love it. If you have good coverage and are happy (or at least tolerating) its costs and suddenly that changes at your expense you don't like it.

 

[Marinejiujitsu]

If you’re in California, Kaiser accepts it, and they are very accessible (maybe depending on what part of CA). I have no problem getting same day primary care appointments. A lot of ER visits can be avoided with accessible primary care. 
I understand statistics > anecdote. I haven’t looked at the data myself. In my measly anecdotal experience, when I didn’t have insurance and therefore didn’t have a primary care, I used the ER a lot more (multiple visits/yr -> 0 visits/yr).
If it’s true that ER visits have increased, I’m curious to see if they might come down as patients grow their relationships with PCPs. When a patient hasn’t had medical care for a long time, it may take some time   for a new PCP to fully address all their health issues (considering time constraints per appointment on PCPs). 

Yeah, besides pockets of pcps in certain counties not accepting it. It still hasn't changed the ER as the PCP. People are kinda stupid in that sense. I have a medical director that always says, "Americans like there medical care like fast food. Get it and go. " Unfortunately, ERs are becoming more efficient and realizing clinic visits to ERs do not usually need labs and imaging. Sometimes, people are discharged in 15 minutes from stepping in that front door. The whole system is jacked. Only thing that can fix it is single payer in my opinion but that would send a blow to our paychecks.

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[PAC94]

I worked in outpatient Internal Medicine when Obamacare rolled out. We had a large influx of patients with numerous complex medical problems who hadn’t had healthcare in years.  Personally,  it has made health care UNAFFORDABLE for my family. I work for a company of about 40-50 employees and the group plan options are a travesty! This year I paid $665 every 2 weeks for a family plan(BCBS PPO) with a $2650 deductible per person, $40 copay for PCP and $60 for specialist. This was up from the prior year by $200 monthly(also BCBS) for a $900 deductible per person, $20 copay for PCP and $40 for specialist. My husband, 2 college aged children and myself are generally healthy and rarely use the plan. Unfortunately this year daughter two had a couple of problems beginning with a bad case of mono..ended up in the ED with abdominal pain, jaundice and bilirubinuria with subsequent GI follow up. She then had an enlarging lateral neck mass requiring workup with ultrasound, CT, FNA(cost of this was almost as much as the actual surgery!) and then surgical excision. Fortunately diagnosis was a benign second branchial cleft cyst. After paying exorbitant premiums my out of pocket costs were over $6000 for all of this.  Just finished open enrollment and employer now has 6 options instead of one so “ everyone has access to an affordable plan”.  The only actual affordable plan is an HMO plan that has a $1000 deductible and costs $575 every two weeks but I can’t  actually choose that plan because you have to live in Texas and I don’t.( company based in TX but employs providers in several states). The next cheapest plan is $575  every two weeks for $7500 deductible per person( including office visits) and the Cadillac plan is $1150 every two weeks for $1250 deductible per person. Soooo..as of today I will have insurance $45 every two weeks for $7500 deductible( my employer pays $460 toward my plan) and my daughters will be applying for something on the exchange. Husband is self employed so not sure about him yet. I spoke with a couple of insurance agents and they all told me that these are pretty typical costs right now and the exchange plans are not any cheaper for us as a family. Not happy with the exchange products as they are also not affordable and most good providers in my area do not accept them but what else are they going  to do. Daughter in college can get insurance through school though that is $350 monthly. Sorry about the novel but I am just so disgusted with Obamacare. “Affordable healthcare for all and you can keep your doctors”. NOT!!!

[GetMeOuttaThisMess]

HD insurance and maxing out HSA contributions with two office visits/yr, one covered 100% for wellness exam, is cheaper for me than higher premium, fixed office co-pay cost.  Each year I look at the cost for a worst case scenario event and for the last two years the better deal is the HD/HSA option.

[Cideous]

I am quitting medicine, moving to California and going on medi-cal.  Statistically, I will be better off.