Congress on the brink of repealing Obamacare

[Nielk]

One story I keep hearing is that US Medicare is not accepted by most doctors as well. One patient I know of has no doctors in the entire area that accept it.

I'm on Medicare and have been able to find some doctors in my town that accept it. The problem is finding good specialists and many doctors are starting to drop it because the Medicare payment to them is pathetic.

We complain that doctors don't spend appropriate time with patients but when you actually see how much Medicare pay them for a visit, it is understandable.

 

[Gingergrrl]

The ACA/Obamacare allowed patients with pre-existing conditions (this includes myself and at least 50% of my family and friends) to get insurance when they could not in the past. In my case, it has covered prescriptions, medical tests, blood work, IVIG, some office visits, and things too numerous to name. It is not a perfect system and I agree it needed improvement but it is better than 20+ million people losing coverage and having nothing. Under the Pre-Obamacare system, if you had something like sleep apnea, lupus, epilepsy, or as basic as a C-section you had a pre-existing condition. A child with a knee injury would be considered a pre-existing condition under the old system. To me, this is a huge step backwards for ME/CFS patients and anyone with a chronic illness or pre-existing condition (which is just about everyone I know).

 

[Nielk]

Pre-existing conditions are covered under the new plan as long as there is no lapse in coverage. In other words if you have coversge now, you will be able to switch to new plan with your re- existing condition.

 

[Gingergrrl]

Pre-existing conditions are covered under the new plan as long as there is no lapse in coverage. In other words if you have coversge now, you will be able to switch to new plan with your re- existing condition.

Sadly I am going to have a lapse in coverage that is unavoidable and will occur, I just do not know when. But this situation is bigger than just me and involves millions of people who will lose their current coverage under the ACA.

 

[Nielk]

Sadly I am going to have a lapse in coverage that is unavoidable and will occur, I just do not know when. But this situation is bigger than just me and involves millions of people who will lose their current coverage under the ACA.

We don't know that yet.

 

[Kenny Banya]

We don't know that yet.

Did you watch the John Oliver video on the previous page?

 

[halcyon]

The insurance companies were losing money, so they started raising prices and raising the deductibles.

Or they were just lying about it for other reasons...
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html

 

[IreneF]

If you are unable to work right now, you are eligible for Medicare/SSD...or you were before ACA.
The Medicare cutback you speak of happened several years ago: "Mysteriously", the acceptance of ME/CFS and similar disabilities by SSA for disability dropped off sharply about a year after ACA/Obamacare took effect. I was informed of this by one of the East Coast's best SSDI lawyers, who has been practicing for over 30 years.

It's no mystery though. The plan's chief architect said that it was deliberately written in an unreadably long, tortuous, bureaucratic form so that voters would not understand what it did. It was predicted that the massive $$$ drain caused by ACA would force many cuts elsewhere, and that happened.

I admit, with great shame, that I was one of those who thought about Obamacare "What a fine thing, someone cares about us!". That often works when one is below age 12, not so often as an adult. I plead the excuse of having this neuro-immune disease, with its consequent brain fog, and near-complete isolation. Of course, life cares nought for such excuses.

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$1900/month plus whatever the deductible is several times more than you can spend on MECFS, because there's almost no effective treatment, and what exists is experimental and not covered by insurance. Of course, some form of insurance for events such as cancer or getting hit by a car is good to have. Previously, you could get that for far less than $22,800/ year, but such plans were outlawed by ACA. You know what's right for you 1000x better than I do, but you might want to go over the numbers and see if the cost + deductible you're paying now is more than paying cash and negotiating a discount, then adding some sort of accident/hospital insurance. But if you are disabled from all work, you should be receiving Medicare and SSDI.

The ACA is flawed mostly because the Republicans forced changes before it would pass Congress. What's interesting is that it's based on the state health plan that Mitt Romney instituted when he was governor of Massachusetts. Romney, in turn, was influenced by the Heritage Foundation, a deeply conservative think tank.

Really what we need is single payer, or a combination public/private plan.

In the short run we would save money without health insurance, but we would be in deep weeds if one of us a heart attack or developed cancer, for example. We had COBRA for 18 months, and it was about $150-200 less per month and had (mostly) better coverage. We couldn't buy that same plan as individuals.

I never applied for disability. I'm not sure why. My husband makes a decent living and I figured it would be means-tested, I guess.

 

[Nielk]

We had COBRA for 18 months, and it was about $150-200 less per month and had (mostly) better coverage. We couldn't buy that same plan as individuals.

Isn't COBRA the system when you continue your existing plan after leaving your job for a limited time?

 

[Nielk]

Or they were just lying about it for other reasons...
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html

I have no trust in insurance companies so I'm sure there are many behind the scenes devious reasons for their actions. But, many companies have pulled out in different states. More are slated to pull out in 2018. It seems like these insurance companies miscalculated how sick many of the people who signed up with them really are.

 

[Nielk]

Did you watch the John Oliver video on the previous page?

Yes very funny and sadly, much of it true.

 

[Gingergrrl]

$1900/month plus whatever the deductible is several times more than you can spend on MECFS, because there's almost no effective treatment, and what exists is experimental and not covered by insurance.

The quote above was taken from post #48 by @IreneF although the actual quote was from someone else. I wanted to reply b/c I am confused where the $1900/mo figure came from? My family and I had an ACA plan since 2014 that covered three people and it was far less than than $1900/mo for all three of us. If I had taken the Cobra plan (from my former job), it would have exceeded $2K per month just for two of us (not three). Without the subsidy, and now paying full price, we still pay far less than $1900/mo.

As much as I've had complaints re: the plan, it has allowed me to do ten months of IVIG which has been the best treatment I have ever done. It covers almost all of my meds (including an EpiPen for $5 vs. $600 if I had no insurance). It covers medical procedures like an upcoming cat scan, it covers all of my blood work, some doctor's office visits (not all), and will hopefully cover another treatment that we are still pursuing. It also covers other conditions like thyroid/ Hashimoto's disease, or random things like seeing a dermatologist or ob-gyn, etc.

And as sick as I have been for four years, I shudder to think of families with children with cancer, and cases far more dire than myself, who will lose coverage. Families will go bankrupt and people will die without insurance coverage. They will flood emergency rooms because they will have no other option but this will not provide them on-going care. I cannot remember ever being so frightened by a piece of legislation and what it will mean for the American people. It is not about political party for me, it is about the system and the people that this will negatively impact.

 

[Mary]

One story I keep hearing is that US Medicare is not accepted by most doctors as well. One patient I know of has no doctors in the entire area that accept it.

Actually a lot of doctors accept straight Medicare, which is administered by the federal government - I was surprised when I discovered this. Straight Medicare (which I have) pays 80% of the approved amount of a doctor's visit. So I generally pay 20% for doctor visits (it's a actually a little more but not significant). And all lab work is covered at 100%. It allows me to see doctors I would not be able to otherwise.

What most doctors won't take are the Medicare Advantage or HMO plans. These plans are administered by insurance companies, supposedly save patients money, but come with all the horrible things associated with HMOs and reimburse even less than straight Medicare.

It is true that most ME/CFS doctors and integrative or functional medicine doctors don't take Medicare, although a few do. But many of them don't take regular insurance either.

 

[Mary]

Obamacare/ACA has become a failure. At first prices were low, but these low prices were no sustainable.

The insurance companies were losing money, so they started raising prices and raising the deductibles.

Many states are left with only one option for medical insurance - which is unaffordable.

People are being forced to buy medical insurance they cannot afford. In addition, deductibles are so high, that they hardly get any benefits from the policy.

Something had to be done to change this dangerous situation.

Whether this new health act will work remains to be seen. We don't know yet how it will end up. Chances are that the Senate will come up with their own version.

Medicare - the federal medical insurance for the disabled in the US remains unchanged. I would hope that most ME patients have Medicare coverage.

In addition, There is Medicaid - federal medical insurance for the poor.

The greatest problem that remains unchanged for us patients is that most ME specialist do not accept any insurance.

This is happening with many specialists around the country. They are unwilling to accept insurance because the coverage is so low - a fraction of their usual fees.

Of course, it is the patients - especially the chronically ill who suffer the most.

You make some really good points, I agree with most of them. However, I don't believe insurance companies were losing money. (see the L.A. Times article referenced in prior posts) I think they just couldn't make as much money as they wanted. It's been reported for years (even before the ACA) that insurance companies were raising premiums annually despite record profits and with no relation to actual costs.

I think the only way to make health care affordable is to have a single-payer plan for all like Medicare. We provide fire departments for everyone regardless of income, they're not profit-making enterprises and the whole idea of health insurance being a profit-making enterprise I think is wrong.

 

[AlwaysTired]

They tried to pass a bill to repeal ACA, what, just a month or two ago? And it was killed because it was so unpopular. And they are trying again already. I just don't get it.

I was wildly disappointed with ACA from the start because it kept insurance companies in the picture. Insurance companies are the biggest problem, and the largest hindrance to truly affordable, universal health care. For profit business and medical care are a disastrous combination. Doctors can't do their job because of them, and even if you're covered they make it a fight to actually pay for needed medical care beyond the basics.

Single payer universal coverage is a better way to go. Insurance companies are useless middlemen.

Also, for anyone saying "just get SSDI/Medicare" please tell me how you got it cause I was already denied Medicaid despite being too disabled from this to work and am now in the process of applying for SSDI, which I know will be a fight.

NB: My state doesn't have expanded Meidcaid but thankfully I am moving to one soon that does. Though whether they will cover the doctors I want to see and the tests etc they may want to order so we can get more answers is the important question!

 

[halcyon]

Also, for anyone saying "just get SSDI/Medicare" please tell me how you got it cause I was already denied Medicaid despite being too disabled from this to work and am now in the process of applying for SSDI, which I know will be a fight.

Get a disability lawyer and make sure you have some kind of documentation of impairment and a supportive doctor. There are several threads here with more detail. Also, once you are approved for SSDI, you have to wait 24 months before you become eligible for medicare.

 

[AlwaysTired]

Get a disability lawyer and make sure you have some kind of documentation of impairment and a supportive doctor. There are several threads here with more detail. Also, once you are approved for SSDI, you have to wait 24 months before you become eligible for medicare.

I've been working with a lawyer since January. Documenting the hell out of this and making sure my doctor does as well. I also have debilitating migraines almost every day, so that's part of my claim, too. I still know it's going to be an uphill battle, because getting SSDI is difficult to begin with and especially for CFS (and migraines, as well).

I will have to find a new lawyer and doctor(s) when I move out of state but that's something I'll probably ask advice on once I'm moved.

 

[Gingergrrl]

They tried to pass a bill to repeal ACA, what, just a month or two ago? And it was killed because it was so unpopular. And they are trying again already. I just don't get it.

I don't get it either (b/c it is not logical) but I think they are just desperate to pass a bill (any bill) to repeal the ACA even if most of the congressmen and women voting for it have not even read it.

For profit business and medical care are a disastrous combination. Doctors can't do their job because of them, and even if you're covered they make it a fight to actually pay for needed medical care beyond the basics.

Agreed as well. The level I have had to fight to get some of my treatments approved is above and beyond anything I could describe.

 

[Kenny Banya]

I think there is a push for universal healthcare with the killing off of the insurance industry, but not from the current administration

 

[AlwaysTired]

I think there is a push for universal healthcare with the killing off of the insurance industry, but not from the current administration

I didn't realize the insurance industry was being killed off, but if that's true, I'm ecstatic. They are a cancer.