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re: What are the economics of Affordable Care Act?
Posted on 9/27/13 at 10:25 pm to wiltznucs
Posted on 9/27/13 at 10:25 pm to wiltznucs
quote:
Here's a link to an independent organization outlining the increases to Medicaid PCP reimbursement. The reimbursement will finally match Medicare. I don't have the CMS data at my fingertips at the moment, I'll dig it up... In short, the ACA has made changes that directly benefit PCP's..
That was supposed to have started this year, but as of yet we have not seen a single damn dime of it and Medicaid continues to deny services AFTER they've been delivered. F#$k Medicaid. Promises are made, but not delivered.
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Posted on 9/27/13 at 11:54 pm to wiltznucs
Medicaid reimbursements are going help doctors in rural area tremulously who decide to take part in Rural Health Clinics. One of the prerequisites is placing a Nurse Practitioner in the clinic at least 50% of the time. I research this data and consult with physicians in various parishes and can tell you in some parishes the reimbursement is over $200 per patient. These are in provider based RHC's (hospitals). In independence RHC's the reimbursement is not as high but for example one of my clients is seeing reimbursements of $33 to $79 on Medicaid. In other words, what happens in under serviced areas with RHC are end up matching Medicare and Medicaid rates.
Posted on 9/28/13 at 12:30 am to Hoyas
I am self employed. I don't have a corporate daddy taking care of me. I have had to fight with insurance companies for the last 15 years just to get minimal coverage with exclusions for my back....I've had 2 back surgeries. Talking to my agent today, looks like I will get better coverage for less money.
Posted on 9/28/13 at 9:33 am to matthew25
quote:None of my clients have resorted to this. But I do not have any clients who use large amounts of unskilled labor.
Poodle: how many of your clients have reduced employee hours to under 30 to meet the requirements of the ACA?
Posted on 9/28/13 at 9:49 am to wiltznucs
quote:
Where the debate exists is whether or not nationalized care is as efficent in terms of timeliness and whether this will meet the expectations of America's immediate gratification oriented society.
WE ARE UNREALISTIC IN OUR EXPECTATIONS ESPECIALLY DEALING WITH END OF LIFE ISSUES. WE ARE NOT REAL GOOD AT LOOKING AT RISK/REWARD IN HEALTHCARE.
Will Physicians and hospitals make less? The data from overseas says yes.
PROBABLY TRUE. I AM A DOCTOR. I HAVE ALREADY "GONE PART TIME". I MAKE ENOUGH TO PAY MY BILLS AND SAVE SOME, BUT WHEN I MADE MORE 50% WENT TO TAXES. I'VE QUIT THE RAT RACE AND AM LOOKING FOR A "RICHER" LIFE INSTEAD OF RICHER LIFESTYLE.
Posted on 9/28/13 at 3:16 pm to Hoyas
quote:
Medicaid reimbursements are going help doctors in rural area tremulously who decide to take part in Rural Health Clinics. One of the prerequisites is placing a Nurse Practitioner in the clinic at least 50% of the time. I research this data and consult with physicians in various parishes and can tell you in some parishes the reimbursement is over $200 per patient. These are in provider based RHC's (hospitals). In independence RHC's the reimbursement is not as high but for example one of my clients is seeing reimbursements of $33 to $79 on Medicaid. In other words, what happens in under serviced areas with RHC are end up matching Medicare and Medicaid rates.
Is it actually being paid in LA? We haven't got shite here...anybody.
Posted on 9/28/13 at 3:22 pm to makersmark1
quote:
Will Physicians and hospitals make less? The data from overseas says yes. PROBABLY TRUE. I AM A DOCTOR. I HAVE ALREADY "GONE PART TIME". I MAKE ENOUGH TO PAY MY BILLS AND SAVE SOME, BUT WHEN I MADE MORE 50% WENT TO TAXES. I'VE QUIT THE RAT RACE AND AM LOOKING FOR A "RICHER" LIFE INSTEAD OF RICHER LIFESTYLE.
This is my plan. Get it while I can then get out. Or be a lazy arse gov't doc. Either way my output will drop dramatically. No reward...no work. Many others will do the same or change fields. If the cut in pay is significant enough. If it's a 5-10% cut maybe not so much. Hell after taxes, I wouldn't notice it anyway.
Posted on 9/29/13 at 1:21 am to matthew25
quote:I'm no poodle of course but, my father owns a decent size firm here in Orlando and most of his clients own small businesses in retail and construction. They are cutting hours of low level employees and have been hiring only part timers but the skilled experienced employees are grandfathered in.
Poodle: how many of your clients have reduced employee hours to under 30 to meet the requirements of the ACA?
Posted on 9/29/13 at 1:31 am to wiltznucs
quote:
I notice a number of folks here blaming Obamacare for decisions their employers made. In many cases Obamacare has been a convenient excuse for employers to reduce their benefit expenditures on their employees.
I one million percent agree with this right here.
quote:
The argument for nationalized healthcare is that the single payer system as it exists elsewhere is more efficient in terms of dollars spent to deliver care. This is an undeniable fact which is not up to debate. The data also suggests that people in countries with nationalized healthcare generally live longer than Americans so even quality is difficult to debate.
Eh, 90+% of this has to do with differences in lifestyles and diet not healthcare.
Posted on 9/30/13 at 11:35 am to FootballNostradamus
quote:
Eh, 90+% of this has to do with differences in lifestyles and diet not healthcare
For sure obesity, fetal mortality, motor vehicle accidents and a host of other differences all factor in. On the other hand the US has very robust food safefy guidelines, OSHA, etc that these other countries may lack.
Like I said, quality is tough to debate because of all the variables at play.
In the end, something had to be done as the previous Medicare model was unsustainable. Is the ACA the answer? I like some respects and others not so much. We'll see how this plays out...
This post was edited on 9/30/13 at 11:37 am
Posted on 9/30/13 at 4:21 pm to Swankie
My partner and I own 4 businesses. It will cost a minimum of $90k and that is if we don't provide it. We are going to divest ourselves of one company to get below the 50 employee max. It will put us at a competitive disadvantage to keep it and won't allow for future growth. So, from my stand point, it will create unemployment and stagnate the economy. And whose to say what banks will do when the newly unemployed stop paying their mortgages.
Posted on 10/1/13 at 5:51 am to Swankie
quote:Frankly, so is every actuary in the industry.
I'm interested in the economics and facts of the program
Effects will be variable depending on industry, age, income and other factors. Economically the ACA is redistributional. In that sense it should have the much same effect as a progressive 10% corporate/personal income tax increase (~$200B/yr, $2T/10years). Under ACA, young healthy policy holders also shoulder an increased burden of older sicker patient costs.
Those businesses which cannot offload ACA costs to employees will take a hit. ACA adds costs directly with increased policy expense, and indirectly in dealing with regulations and penalties. As with any corporate tax, those costs, where possible, will be passed through. Could add another 2% or more to inflation, a near double in this market.
Health insurance carriers will be pressured. IMO, investment in that sector is at risk. ACA limits profitability via the 80% rule. It increases actuarial risk due to variance in young healthy participation. With fewer healthy members, costs will rise. Carriers' policy options are limited under the ACA, also rendering cost of coverage more expensive.
Hospitals, Clinics, and Medical personnel will be affected. How significantly, is anybody's guess. Hospital administrators remain in a quandary about revenue effects. Layoffs have commenced. Physicians are closing practices in favor of employment usually via hospitals. Economic effects via the medical industry? I'd guess, not much. Leadership transference from physicians to administrators and politicians is another thing entirely. Effects on the public will eventually be significant. My suspicion is hospitals and doctors will see little economic change when the dust settles.
Miscellaneous pockets include Big Pharma - winner. Med device makers - losers.
In general terms of healthcare sector performance and investment, track Medicaid expansion. There should be an inverse relationship between Medicaid growth and HC sector profitability.
Posted on 10/1/13 at 6:08 am to wiltznucs
quote:Represents a perfect example of leadership transformation as noted in the post above. Care decisions and concepts for Americans will flow from physicians who actually understand healthcare to administrators who "did considerable work debating" it.
The argument for nationalized healthcare is that the single payer system as it exists elsewhere is more efficient in terms of dollars spent to deliver care. This is an undeniable fact which is not up to debate. The data also suggests that people in countries with nationalized healthcare generally live longer than Americans so even quality is difficult to debate. Where the debate exists is whether or not nationalized care is as efficent in terms of timeliness and whether this will meet the expectations of America's immediate gratification oriented society.
This post was edited on 10/1/13 at 6:15 am
Posted on 10/1/13 at 8:40 am to NC_Tigah
Nice analysis. For many Americans ACA will simply be a redistributive program. They will not notice a material change in health care's share of the economy. It will effectively be a zero sum game to those people. Whether they are winners or losers in the game will be apparent to them real soon. Obama, and the Democrats, bet that the winners will outnumber the losers and reward them in the voting booth.
The Democrats realize they missed the mark, and will likely lose their bet. Thus, Obama has been trying to rig the game to change the perceptions of who is winning v. losing until after the next election.
The Democrats realize they missed the mark, and will likely lose their bet. Thus, Obama has been trying to rig the game to change the perceptions of who is winning v. losing until after the next election.
Posted on 10/1/13 at 4:07 pm to Swankie
quote:
I've never actually asked a doctor what his or her thoughts were on "Obamacare," but I'm very much interested.
I was talking to the doctors I work with today about it. They aren't too happy about it. The doctors are getting screwed pretty hard in this deal especially since their compensation is already dropping. It's just a huge disaster. I wouldn't be surprised if there's a huge physician strike in a few years. Docs aren't getting paid enough to even cover their overhead costs.
Posted on 10/1/13 at 4:10 pm to Captain Ron
quote:
Crash the current health care industry so the government can go to a single-payer system.. i.e. taxpayers paying for more free shite to freeloaders.
it might happen but we will never be a single-payer system. The government will go bankrupt.
Posted on 10/1/13 at 4:14 pm to 2geaux
quote:
So, from my stand point, it will create unemployment and stagnate the economy
exactly, so who will be paying the taxes for this new healthcare exchange?
If i could change one thing in ACA, it would be the pre-existing conditions clause for the private payers because we need them to cover those that can afford it. Now, the new insurance exchange is going to have to cover all of these new people that can't afford the increased premiums due to the pre-existing conditions clause.
Posted on 10/1/13 at 4:22 pm to Burt Reynolds
quote:
Docs aren't getting paid enough to even cover their overhead costs.
how can this be true? how are they in business? serious question.
Posted on 10/1/13 at 4:30 pm to tigermoney
quote:
how can this be true? how are they in business? serious question.
I was talking about govt insurance. I don't think primary care doctors will get paid enough to stay in business in the future if their payer mix consists of majority medicare/medicaid (govt insurance).
Can you tell me how a private practice doctor could stay in business with a 100% medicaid payer mix?
This post was edited on 10/1/13 at 4:33 pm
Posted on 10/1/13 at 5:32 pm to Burt Reynolds
quote:
was talking about govt insurance. I don't think primary care doctors will get paid enough to stay in business in the future if their payer mix consists of majority medicare/medicaid (govt insurance). Can you tell me how a private practice doctor could stay in business with a 100% medicaid payer mix?
Medicaid doesn't pay shite. Medicare is ok. Blue Cross pays great. I do just fine with about a 60/40 mix of private insurance and medicare with very little Medicaid. Now if I was 100% mcare/caid, I'd be f$%ked. I'd make a decent living though, because I've kept my overhead low.
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