How has the AFA affected your health costs?

[Like2Plan]

And personally, how has it impacted your finances?

I haven't seen much of a change. My healthcare insurance is up, but that is no change from before ACA--it has always gone up a small percentage each year.

DH's has always gone to a PA before ACA-- who would give him referrals if something needed more attention.
I go to a different practice. I haven't tried to schedule a physical for this year, yet, so I don't know if that will be any different. They've always been pretty busy, so there is a generally a long lead time needed. Thankfully, I haven't had to make any visits apart from the physical.

The prescription drugs are something that continues to cause aggravation. DH and I each have a long term prescription. The latest thing is the ins will not pay for name brand. Between our 2 insurances, DH's meds used to be no additional cost. So, DH switched to generic and there was a co-pay.

[FrugalFish]

The ACA has caused my health coverage at work to change around quite a bit.

We went to a tiered plan and a lot of the copays have been replaced with deductibles. There are a lot more out of pocket costs than there used to be.

I personally don't use my health coverage very much, so personally it hasn't had much of an effect on me.

Same story here.

We are with a rather well-reputed HMO, but after ACA went into affect, they changed their approach, so that many things were no longer treated. For example, DH developed a small growth on the side of his head that bled constantly. Prior to the ACA, he would have been able to go to the HMO doc and get treatment. After ACA, the doctor (who he likes and has seen for years) apologized and said that under their new standards of treatment it was considered a "benign" condition (despite the constant bleeding) therefore something they no longer treat. He would have to find a private dermatologist and pay out of pocket.

We've learned a lot about successful "don't try this at home" home remedies since then.

As I understand it, they are still doing a very good job with their patients if you have a major condition. Unfortunately, being discouraged about seeing a doctor for minor conditions, doesn't help one catch problems early.

[safari]

The cost of my employer-sponsored PPO medical insurance actually went down. Even though my deductible is now a lot higher than it used to be, I now qualify for the HSA and my company deposits $750 into my HSA every year, which is usually enough to cover all my medical expenses for a year. Previously my monthly payment was higher and I had to pay copayments out of my own pocket, so I am liking the new system quite a bit.

[disneysteve]

Yeah, but business is good, right?

Sure, if by "good" you mean more work without any more pay.

[safari]

Sure, if by "good" you mean more work without any more pay.

I am a bit confused. If you're seeing the same number of patients a day, then how is that more work? If you're working extra hours to see more patients, then you should be getting paid more. Can you elaborate what you meant?

[disneysteve]

I am a bit confused. If you're seeing the same number of patients a day, then how is that more work? If you're working extra hours to see more patients, then you should be getting paid more. Can you elaborate what you meant?

Sure. I'm working the same number of hours but seeing more patients. I'm paid by the hour so that doesn't result in any change to my income.

The result of more patients in a practice tends to be the doctor spending less time with each patient. It doesn't lead to better care, of course. Just the opposite, in fact. That's why what we really need is more providers, not just more patients.

[safari]

Sure. I'm working the same number of hours but seeing more patients. I'm paid by the hour so that doesn't result in any change to my income.

The result of more patients in a practice tends to be the doctor spending less time with each patient. It doesn't lead to better care, of course. Just the opposite, in fact. That's why what we really need is more providers, not just more patients.

I see. I thought you had your own practice instead of being paid hourly. If your employer is making you see more patients a day by spending less time with each patient, that's unfair to you and your patients. Your employer is profiting from the increase in the number of patients, but you're still making the same money while doing more work. Have you tried bringing this up with your boss and asking for a raise?

[disneysteve]

I see. I thought you had your own practice instead of being paid hourly. If your employer is making you see more patients a day by spending less time with each patient, that's unfair to you and your patients. Your employer is profiting from the increase in the number of patients, but you're still making the same money while doing more work. Have you tried bringing this up with your boss and asking for a raise?

My income hasn't totally been flat. I do get paid for a few more hours per week than I used to. I also recently started getting paid separately for doing a certain type of exam that used to just be included in my regular pay.

A big part of the problem is that more patients also means more overhead. We have the most employees that we've ever had in the 15 years I've worked here. We needed more people to handle all of the extra work that has come with higher patient volume and ever-increasing reporting demands from insurance companies. So while the practice gross income may be higher with more insured patients, so are practice expenses.

I'm very happy in my job overall, so I don't want it to sound like I'm not, but there are certainly problems in medicine that aren't getting any better anytime soon. ACA is just one part of that.

[feh]

The ACA hasn't affected my health care costs.

What it will do for me in the future (probably next year), is allow me to retire, as I'll have a guaranteed source of insurance, even though I won't be employed. It's the Patient Protection part of the PPACA that I'm most happy about.

[disneysteve]

The ACA hasn't affected my health care costs.

What it will do for me in the future (probably next year), is allow me to retire, as I'll have a guaranteed source of insurance, even though I won't be employed.

Very true. That's something we don't often hear about. My cousin took advantage of that too. He retired at age 55 and with ACA I think he's paying less for his insurance now than he was when he was working. It will nicely carry him until he is old enough for Medicare.

[Weird Tolkienish Figure]

The affect of adding new patients but not new doctors was seen in MA as well, I tried to explain this to people blathering on about "single payer". You need a mechanism to encourage new doctors, period!

I actually don't have a problem with the ACA... in theory. My biggest complaint about it is the stuff it forces down your throat: maternity coverage for men for example. Mental health care, etc. etc.

We need more choice in life, not less.

[disneysteve]

You need a mechanism to encourage new doctors

Even if ACA had some structure to encourage new doctors, the soonest that would have an impact on the actual doctor supply would be 7 years from now. In the meantime, you've got longer waits, shorter visits, and more harried doctors.

I've read a few reports that one of the intended outcomes of ACA hasn't panned out - decreased use of emergency rooms for non-emergent care. In fact, in some places it has actually increased. Why? 1) More people have insurance so they can use the ER without fear of it bankrupting them and 2) Doctors are swamped so even though the patients now have insurance, they may not be able to get a prompt appointment to be seen when they have a problem.

[Weird Tolkienish Figure]

Even if ACA had some structure to encourage new doctors, the soonest that would have an impact on the actual doctor supply would be 7 years from now. In the meantime, you've got longer waits, shorter visits, and more harried doctors.

Good point, but we could adjust immigration policy to let skilled doctors and nurses (and other highly educated types) go to the front of the line. Other countries like Canada do it.

[ua_guy]

My income hasn't totally been flat. I do get paid for a few more hours per week than I used to. I also recently started getting paid separately for doing a certain type of exam that used to just be included in my regular pay.

A big part of the problem is that more patients also means more overhead. We have the most employees that we've ever had in the 15 years I've worked here. We needed more people to handle all of the extra work that has come with higher patient volume and ever-increasing reporting demands from insurance companies. So while the practice gross income may be higher with more insured patients, so are practice expenses.

I'm very happy in my job overall, so I don't want it to sound like I'm not, but there are certainly problems in medicine that aren't getting any better anytime soon. ACA is just one part of that.

I can see how it would put even more pressure on small clinics and even small physician groups to maybe want to join forces, or become hospital based. None of that overhead is cheap and there can be good savings in consolidating operations and sharing IT platforms.

My doc is part of a small clinic run by 4 physicians and just a handful of office staff. They're hanging on, but I know it's tough.

[corn18]

I've read a few reports that one of the intended outcomes of ACA hasn't panned out - decreased use of emergency rooms for non-emergent care. In fact, in some places it has actually increased. Why? 1) More people have insurance so they can use the ER without fear of it bankrupting them and 2) Doctors are swamped so even though the patients now have insurance, they may not be able to get a prompt appointment to be seen when they have a problem.

We've seen this. The lead time for an appointment with our general family doctor for non-emergent care is 3-6 months. She is booked solid. Get sick, the wait is 5 days. We just go to the local urgent care place now because of this. And that is very busy, too but at least you can be seen that day.

Now try to get a psychologist or psychiatrist. We cannot find one that is accepting new patients. Won't even take our info. All full up. Mental health is not well cared for in the U.S.