Polls show obamacare wave building against senate democrats

[Daverino]

If my insurance goes up more than your 15%; then is must be that I am paying more than before ObamaCare.

And people accuse me of seeing things in black and white.

Why would a jump in your insurance rate be extra money you're paying for the ACA? You've shown correlation, but you haven't shown causation.

 

[Doc Savage Fan]

The purpose of my comment was that people are saying that instead of spending money on the ER for an uninsured; spend it on the subsidy for their insurance. But I am still having to do both; spend it on the ER (I get no refund due to less is going directly to the ER) and subsidizing others.

It's pretty much a given that Obamacare will do very little to fix the ER problem.

 

[Daverino]

No, you do fit my stereotype -- full of unwarranted arrogance and hypocrisy. :awe:

People who are consistently correct and rely on "facts" and "reason" are often accused of being arrogant and hypocritical. It's a burden we liberals deal with daily. But at least we get to be right all the time, so we got that going for us.

 

[Daverino]

It's pretty much a given that Obamacare will do very little to fix the ER problem.

Citation please.

 

[Doc Savage Fan]

Citation please.

Why? Would it make any difference to you if what I'm saying is true?

 

[Daverino]

Why? Would it make any difference to you if what I'm saying is true?

Yes. I like facts and learning things.

I'll go first.

 

[IndyColtsFan]

People who are consistently correct and rely on "facts" and "reason" are often accused of being arrogant and hypocritical. It's a burden we liberals deal with daily. But at least we get to be right all the time, so we got that going for us.

Yes, you're legends in your own minds. If only you guys were as correct as often as you think you were.

 

[Doc Savage Fan]

Yes. I like facts and learning things.

I'll go first.

http://deepblue.lib.umich.edu/bitstream/handle/2027.42/91230/j.1553-2712.2012.01313.x.pdf?sequence=1

http://www.ucsf.edu/news/2013/09/108901/surging-medicaid-use-california’s-emergency-rooms

More adults in California are flocking to emergency rooms, especially those on Medicaid who are using ERs at a faster rate than the uninsured or privately insured, according to new UC San Francisco research.

The researchers say the findings could reflect a nationwide trend under the Affordable Care Act. Many uninsured people are expected to transition to Medicaid, and as a result, overall emergency department use may increase because Medicaid patients have higher rates of ER use, as the study found. At the same time, some states are proposing cuts to Medicaid or refusing to expand it, which could exacerbate waiting time in the ER.

http://www.businessweek.com/article...are-emergency-rooms-may-get-even-more-crowded

When Massachusetts passed a health-care reform law in 2006 that provided coverage for nearly everyone, hospitals were surprised to find a 4 percent rise in ER visits, according to a 2011 study of 11 medical centers published in the Annals of Emergency Medicine. The Affordable Care Act likewise may not relieve pressure on ERs, says Peter Smulowitz, an instructor at Harvard Medical School and the lead author of the study. “Health planners and states should start preparing for an increase in ER visits,” he says. “There will be higher demand.”

http://kstp.com/article/stories/s3196719.shtml

The best case study for health care reform is in Massachusetts, where universal health care was enacted in 2006. According to state data, emergency room visits increased 6 percent from 2006 to 2010.

 

[EagleKeeper]

If one has insurance; they are not worried about using it.
However, if the MD is not available at that instant; the UR or ER can be used because you no longer have the stigma of not being able to pay or being chased for payment later.

If we are adding 10% of the population to use the Medical system and the system is not setup to handle the increase load; then the load shifts elsewhere; public facilities.

 

[Daverino]

http://deepblue.lib.umich.edu/bitstream/handle/2027.42/91230/j.1553-2712.2012.01313.x.pdf?sequence=1

http://www.ucsf.edu/news/2013/09/108901/surging-medicaid-use-california’s-emergency-rooms



http://www.businessweek.com/article...are-emergency-rooms-may-get-even-more-crowded



http://kstp.com/article/stories/s3196719.shtml

Actually that's some pretty interesting stuff, thank you. It's a bit counter-intuitive on the first read, but it does make sense in the end.

Unfortunately, that's not really the issue here. The issue is not whether or not Medicaid recipients use the ER. It's whether or not the ER gets compensated after a visit. The ER will get compensation if a Medicaid patient visits, but not necessarily when an uninsured patient does. It's those 'walk-outs' that end up getting other visitors billed more heavily.

So I agree with you that moving a large number of poor onto Medicaid will increase the volume of ER visits overall. But those will be compensated visits, where previously they would not have been.

 

[Doc Savage Fan]

Actually that's some pretty interesting stuff, thank you. It's a bit counter-intuitive on the first read, but it does make sense in the end.

Unfortunately, that's not really the issue here. The issue is not whether or not Medicaid recipients use the ER. It's whether or not the ER gets compensated after a visit. The ER will get compensation if a Medicaid patient visits, but not necessarily when an uninsured patient does. It's those 'walk-outs' that end up getting other visitors billed more heavily.

So I agree with you that moving a large number of poor onto Medicaid will increase the volume of ER visits overall. But those will be compensated visits, where previously they would not have been.

The ER problem is not just about hospital compensation in my opinion...here's a short article that you may find interesting.

http://www.physicianspractice.com/blog/emergency-rooms-continue-serve-patients-primary-care-provider

Bottom line...I think it's pretty clear that the ER problem is not going away due to ACA legislation.

 

[boomerang]

If one has insurance; they are not worried about using it.
However, if the MD is not available at that instant; the UR or ER can be used because you no longer have the stigma of not being able to pay or being chased for payment later.

If we are adding 10% of the population to use the Medical system and the system is not setup to handle the increase load; then the load shifts elsewhere; public facilities.

It continually amazes me that what is common sense, that can be derived from easily known facts, is a revelation to the progressive left - if they're actually listening. Conservatives have been beating the drum about the pitfalls of this legislation since it was passed in the dead of night. The overwhelming majority of it has come to pass. Who's surprised? The progz. But they haven't given up demonizing the right yet.

We had to pass the bill to find out what is in it and we've got to let it all play out over the next decade to know if it's good or not. Not one lick of common sense among any of them.

In related news, they've been screaming for this and it has arrived. DOA is pretty much a certainty because more than likely the only thing the progressive left will accept is the exact same bill they passed except with more subsidies.

Republicans have an alternative to Obamacare, and it could save $2.34 trillion

Watch them tear it apart. Their ego's won't allow for them to upstaged.

 

[theeedude]

It continually amazes me that what is common sense, that can be derived from easily known facts, is a revelation to the progressive left - if they're actually listening. Conservatives have been beating the drum about the pitfalls of this legislation since it was passed in the dead of night. The overwhelming majority of it has come to pass. Who's surprised? The progz. But they haven't given up demonizing the right yet.

We had to pass the bill to find out what is in it and we've got to let it all play out over the next decade to know if it's good or not. Not one lick of common sense among any of them.

In related news, they've been screaming for this and it has arrived. DOA is pretty much a certainty because more than likely the only thing the progressive left will accept is the exact same bill they passed except with more subsidies.

Republicans have an alternative to Obamacare, and it could save $2.34 trillion

Watch them tear it apart. Their ego's won't allow for them to upstaged.

It's a BS bill that won't work:

As for helping the uninsured, the law is marginally less effective than Obamacare, since EPFA doesn’t include the individual mandate. By 2023, the increase in insured Americans would be 5 percent less.

EPFA accomplishes these gains while providing guaranteed coverage for pre-existing conditions, as does Obamacare.

You can't guarantee coverage for pre-existing conditions without individual mandate. Otherwise people will wait till they are sick to get insurance.
This bill doesn't even stand up to basic scrutiny.

 

[fskimospy]

Don't you understand? There will be so much FREEDOM that adverse selection won't exist anymore.

Yet another entry in the "I can't believe people are gullible enough to believe this shit" log. Republican leadership truly has utter contempt for the brainpower of conservatives in the US.

 

[OverVolt]

Citation please.

Because homeless people aren't going to sign up for obamacare?

Unless they can do it from their obamaphone on walmarts wi-fi while buying some junk food with food stamps.

A website isn't going to fix people being poor is what I'm trying to get at. There is no debtors prison, if you have no assets for them to go after what do you care? You need a citation for that?

 

[Matt1970]

We had to pass the bill to find out what is in it and we've got to let it all play out over the next decade to know if it's good or not. Not one lick of common sense among any of them.

quoted for posterity

 

[Daverino]

Because homeless people aren't going to sign up for obamacare?

Unless they can do it from their obamaphone on walmarts wi-fi while buying some junk food with food stamps.

A website isn't going to fix people being poor is what I'm trying to get at. There is no debtors prison, if you have no assets for them to go after what do you care? You need a citation for that?

Homeless people, assuming they aren't making 15 grand a year, aren't eligible for Obamacare (exchange-based insurance). If you didn't know that already, you probably shouldn't be posting in this thread. . .

 

[werepossum]

Actually that's some pretty interesting stuff, thank you. It's a bit counter-intuitive on the first read, but it does make sense in the end.

Unfortunately, that's not really the issue here. The issue is not whether or not Medicaid recipients use the ER. It's whether or not the ER gets compensated after a visit. The ER will get compensation if a Medicaid patient visits, but not necessarily when an uninsured patient does. It's those 'walk-outs' that end up getting other visitors billed more heavily.

So I agree with you that moving a large number of poor onto Medicaid will increase the volume of ER visits overall. But those will be compensated visits, where previously they would not have been.

It might decrease the volume of ER visits overall, if these people can be trained to go to a doc-in-a-box rather than to an ER. Once they've experienced a two hour wait rather than a four hour wait, hopefully they will visit the doc-in-a-box whenever they don't have an injury/illness which will get them seen on a priority basis. While providing them with health insurance will increase the total cost of health care in America, if they can be weaned away from the ER with its extreme costs then this increase can be mitigated to a large extent. It simply costs less to provide an exam and a prescription at a doc-in-a-box than at an ER.

 

[Daverino]

It might decrease the volume of ER visits overall, if these people can be trained to go to a doc-in-a-box rather than to an ER. Once they've experienced a two hour wait rather than a four hour wait, hopefully they will visit the doc-in-a-box whenever they don't have an injury/illness which will get them seen on a priority basis. While providing them with health insurance will increase the total cost of health care in America, if they can be weaned away from the ER with its extreme costs then this increase can be mitigated to a large extent. It simply costs less to provide an exam and a prescription at a doc-in-a-box than at an ER.

That was my assumption before reading the articles. But as they point out, finding a reliable PCP for a Medicaid recipient is hard. And regardless, supplies are not going to increase with demand here. The thing that I didn't really think about is that patients with Medicaid are more inclined to visit the ER because they know they don't have to walk out on the bill. What that implies is that the uninsured and non-Medicaid receiving poor will avoid the ER because they can't pay. Effectively, the ER would be free for them, but they still don't go.

Once the poor uninsured have Medicaid, though, they feel more entitled to go to the ER because they are covered. So I think Doc and I were just making separate points and I think both are correct On the one hand, moving poor uninsured people to Medicaid will reduce the number of uncompensated visits. On the other hand, moving poor uninsured to Medicaid will increase demand on ER services without a commensurate increase in supply of ER services. For the insured, I see it having two possible consequences. It could drive insurance costs down because hospitals would no longer have to inflate costs to handle uncompensated visits. It could also reduce the access of everyone, including the insured, to timely emergency services. I suppose the hypothesis is that the two will offset each other; increased revenue for the hospital will allow them to keep pace with the influx of demand. But economics being what it is, I can't see those two things happening simultaneously.

 

[sactoking]

It's a BS bill that won't work:


You can't guarantee coverage for pre-existing conditions without individual mandate. Otherwise people will wait till they are sick to get insurance.
This bill doesn't even stand up to basic scrutiny.

Just as a point of fact, while the individual mandate is important to counteracting the antiselection inherent in no pre-ex it is no more important than an oft-overlooked rule: limited enrollment periods. Technically no-pre ex can still work with a limited enrollment period. While this would not stop antiselection on long-term and chronic maladies it would more or less stop antiselection on short-term afflictions.

Theoretically, this might work, but it would be risky.

 

[Doc Savage Fan]

Just as a point of fact, while the individual mandate is important to counteracting the antiselection inherent in no pre-ex it is no more important than an oft-overlooked rule: limited enrollment periods. Technically no-pre ex can still work with a limited enrollment period. While this would not stop antiselection on long-term and chronic maladies it would more or less stop antiselection on short-term afflictions.

Theoretically, this might work, but it would be risky.

What do you think about assigned risk pools for those with pre-existing conditions where insurance companies doing business in a particular state must take a proportion of the pool based on their premium base within the state? Sort of like they do with wind exposure in coastal areas. Perhaps they could apply the concept on a national basis instead.

 

[sactoking]

What do you think about assigned risk pools for those with pre-existing conditions where insurance companies doing business in a particular state must take a proportion of the pool based on their premium base within the state? Sort of like they do with wind exposure in coastal areas. Perhaps they could apply the concept on a national basis instead.

I haven't given it much thought but I don't think it would make anything better. Remember that HIPAA created Basic and Standard plans for high risk individuals and states and the fed did have high-risk pools. The Basic and Standard plans were effectively garbage insurance and the high-risk pools became insolvent. You wouldn't be able to spread the risk to a separate risk pool and maintain solvency, the high-risk individuals would need to be part of the general risk pool. At that point, what are you really gaining by assigning risks? You're eliminating the individual's freedom to choose and not creating a system any different than the one that will exist 1/1/14.

 

[werepossum]

That was my assumption before reading the articles. But as they point out, finding a reliable PCP for a Medicaid recipient is hard. And regardless, supplies are not going to increase with demand here. The thing that I didn't really think about is that patients with Medicaid are more inclined to visit the ER because they know they don't have to walk out on the bill. What that implies is that the uninsured and non-Medicaid receiving poor will avoid the ER because they can't pay. Effectively, the ER would be free for them, but they still don't go.

Once the poor uninsured have Medicaid, though, they feel more entitled to go to the ER because they are covered. So I think Doc and I were just making separate points and I think both are correct On the one hand, moving poor uninsured people to Medicaid will reduce the number of uncompensated visits. On the other hand, moving poor uninsured to Medicaid will increase demand on ER services without a commensurate increase in supply of ER services. For the insured, I see it having two possible consequences. It could drive insurance costs down because hospitals would no longer have to inflate costs to handle uncompensated visits. It could also reduce the access of everyone, including the insured, to timely emergency services. I suppose the hypothesis is that the two will offset each other; increased revenue for the hospital will allow them to keep pace with the influx of demand. But economics being what it is, I can't see those two things happening simultaneously.

Interesting. My understanding was that the poor and uninsured used the emergency room for all their health care needs because the emergency room has to treat you regardless of ability to pay - although I know many private hospitals not accepting government money have long tried to triage patients, so that those whose condition does not require immediate emergency care are sent to hospitals which do take government money to cover treating indigents.

Just as a point of fact, while the individual mandate is important to counteracting the antiselection inherent in no pre-ex it is no more important than an oft-overlooked rule: limited enrollment periods. Technically no-pre ex can still work with a limited enrollment period. While this would not stop antiselection on long-term and chronic maladies it would more or less stop antiselection on short-term afflictions.

Theoretically, this might work, but it would be risky.

That's a good point. I think the mandate concept has been irrevocably screwed anyway by shifting costs to the young and presumably healthy, discouraging them from buying insurance. If that cost shifting is removed, so that each individual pays the rate for his age group but without special adjustment for his circumstances, then everyone's insurance goes up a little but no one's insurance doubles or triples. (For the same coverage; obviously if you had crap insurance, your cost for good insurance is going to be much higher.)

 

[Doc Savage Fan]

I haven't given it much thought but I don't think it would make anything better. Remember that HIPAA created Basic and Standard plans for high risk individuals and states and the fed did have high-risk pools. The Basic and Standard plans were effectively garbage insurance and the high-risk pools became insolvent. You wouldn't be able to spread the risk to a separate risk pool and maintain solvency, the high-risk individuals would need to be part of the general risk pool. At that point, what are you really gaining by assigning risks? You're eliminating the individual's freedom to choose and not creating a system any different than the one that will exist 1/1/14.

I was just thinking of a possible alternative to the mandate mechanism for insuring/subsidizing those with pre-existing conditions by having insurance companies fund the pools and defray costs of doing so with premium surcharges for all policyholders. Solvency of the pools would in effect be guaranteed by the insurance companies. But now that I think about it a little longer I see that it would only increase to cost of coverage for everyone currently insured and does nothing to incent the uninsured and younger people to insure to help fund the pools. It seems that there is no way around the individual mandate if we want to insure those with pre-existing conditions at a relatively reasonable cost.

 

[theeedude]

Just as a point of fact, while the individual mandate is important to counteracting the antiselection inherent in no pre-ex it is no more important than an oft-overlooked rule: limited enrollment periods. Technically no-pre ex can still work with a limited enrollment period. While this would not stop antiselection on long-term and chronic maladies it would more or less stop antiselection on short-term afflictions.

Theoretically, this might work, but it would be risky.

Actually, this act guaranteeing coverage for pre-existing condition, as does Obamacare, was a bold faced lie.
https://www.govtrack.us/congress/bills/113/hr2300/text

Straight from the bill's text:

Sec 3.
No mandate of guaranteed issue or community rating

Nothing in this Act shall be construed to provide a mandate for guaranteed issue or community rating in the private insurance market.

So basically this bill doesn't do much of anything to reform health care.