How Much for That Shoulder Replacement?

Forgive the blog silence, I’ve been online trying to sign up for health insurance on www.healthcare.gov (just a little healthcare reform humor there).

So today we’re going to do a bit of math. Don’t worry — I’m not a math person so this will be simple and painless.

We’re going back to my aunt, who was prominently featured in my last post.

She’s doing quite well ( thanks to all who sent good wishes). And she just received the first of what will be many bills.

This one was for the surgery and hospitalization. The hospital billed Medicare $11,851. Keep in mind that’s for the hospital only. Not the radiologist who read her xrays, or the anesthesiologist who made sure she felt no pain, or the surgeon who replaced her shoulder, or the visiting nurse, or the physical therapist, or the outpatient prescription medications. Just the facility charges for the surgery and three days in the hospital.

Medicare and her supplemental insurance paid the hospital $2,016 — about 17 percent of the total charges (don’t worry, I used an online calculator to figure this out). She had no copay thanks to that supplemental insurance.

If she didn’t have insurance, however, … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform healthcare system;

Healthcare.gov — Fail!

Yes, it’s a mess. No, I’m not talking about 17-year-old’s bedroom (the mounds of laundry on the floor and 15 empty Gatorade bottles on his desk are fodder for another blog) but, of course, healthcare.gov, the web site that is the gateway to individual insurance for millions of Americans but which, unfortunately, is working about as well as Congress.

In case you haven’t noticed, I’m a pretty big advocate of healthcare reform and, despite its many flaws, the Affordable Care Act. Which is why I feel like curling up in a fetal ball in the recesses of the teenager’s (scary) closet and not coming out until an entire day goes by without a story on NPR about healthcare.gov.

Unfortunately, I still have to earn a living so the closet is not an option.

So I will face the critics and admit it. Yes, the Obama administration screwed this up in the most humiliating, embarrassing way. Then I will tell them what I tell my kids: Now what?

We can point fingers and whine and moan about how bad things are, or we can focus our energy on fixing the problem. Obviously, since this is the federal government, many heads will … Continue Reading

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More Questions About the Affordable Care Act

Before I get into the questions, I want to invite you to visit the Health Care Reform page for Prevention magazine. I’m now the editor-at-large for healthcare reform for Prevention, and have a story on the ACA in the October and November issues.

You can also participate in a Twitter chat with me on Monday, September 30, from 1-2 p.m. eastern. Join in using hastag #PVNHealth. My handle is @debragordon2012.

Plus, I have a couple of questions of my own:

 

— When people say that Americans “hate” the ACA and that the ACA is “destroying” the country, what do they mean, exactly? I think most Americans don’t understand the Act. . . how can you hate something you don’t understand? And I really want to know how it is destroying the country. Really.

— Why are people so opposed to providing a way for people who can’t get or can’t afford health insurance to get health insurance? No one 65 and older seems to be complaining about the Medicare program they participate in.

I also recommend this article in today’s Washington Post, where you can read about real people and the ACA.

 

Now, onto the questions (and please … Continue Reading

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Affordable Care Act health insurance health insurance exchanges healthcare costs healthcare reform Obamacare

Your Questions About the Affordable Care Act

I can’t take it anymore. I just can’t take the lies and misinformation out there about the Affordable Care Act (ACA) and healthcare reform. Nearly ever  time I tell someone something about the Act, or answer a question, they are surprised at how the truth differs from what they’ve heard.

To that end, I put out the word to friends and others to send me their questions about the ACA. Here’s the first batch. If you have any questions, send them on. I’ll keep answering them until we run out.

Question: Are the insurers currently participating in the system locked in on Jan 1st? Can they decide to pull out during the year?

Answer: If they decide to participate in the exchanges they must provide coverage for the year so no, they can’t pull out during the year. The only reason they can cancel your coverage is if you lie on the application.

Question: How will income be calculated?

Answer: Based on adjusted gross income (AGI), which includes certain deductions. Note that income is based on your household income, not individual, and that it is based on estimated income for the following year. If you estimate wrong and received a … Continue Reading

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Affordable Care Act health insurance health insurance exchanges healthcare costs healthcare reform healthcare system; Obamacare

Three Weeks and Counting

Can you feel the excitement in the air? Yes, it’s fall. Yes, it’s football season. Yes, wrestling is back in the Olympics. But that’s not what I’m talking about. I’m talking about the launch of the state and federal health insurance exchanges–the cornerstone of the Affordable Care Act–on October 1.

I don’t know about you, but I can barely sit still I’m so excited!

Ok, I admit that I am a health policy addict and I’m looking for a 12-step program. But seriously, these exchanges have the potential to revolutionize how we get health care in this country, provide an important burst of energy to the development of small businesses and entrepreneurship, and impact the health of a large chunk of the population.

These are grand goals, I know. So let’s swoop down from the 50,000-foot view that most of us have received from the media to the ground level. Let’s talk about two women, Sharon and Karen.

Sharon is a good friend of mine, a Realtor in her 50s. As such, she’s self-employed and has to purchase her own health insurance. Sharon is very healthy today–but she had a severe cardiovascular complication after her son’s birth 26 years ago. … Continue Reading

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Affordable Care Act health insurance health insurance exchanges healthcare reform Obamacare

Wise Words From a Retired Hand Surgeon

Those of you who know me know I like wine. A lot. And food. Even more.

Put the two together and I’m there! So that’s where I was last night, at a wine tasting dinner enjoying the wines from Ferrari-Carano, which, by the way, are excellent and very reasonably priced (we bought a case).

We were sitting across from an older couple and, of course, got to talking. Turns out he’s a retired hand surgeon from New Jersey who retired to Williamsburg. He heard me say that I was giving a talk about healthcare reform.

“I figured out how to fix the healthcare system,” he said.

At this point, I kicked my husband under the table. I was sure I was about to be treated to some diatribe about “Obamacare” and getting the government out of healthcare, and vouchers and moochers (most members of the wine club that hosted the dinner are, ahem, somewhat conservative).

But I’m learning about Buddhism, trying to be more patient and to listen, really listen, rather than always jumping in. So I bit my lip, took a deep swallow of the red, and listened. Then he said the sentence that brought joy to my heart:

… Continue Reading

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Healthcare Reform 2.0: Five things you need to know to grow your business in 2013

How much do you know about healthcare reform — and I don’t mean just the Affordable Care Act (aka “Obamacare”). I mean the coming tsunami of change that has the potential to completely revamp one of the most dysfunction systems in our country (as you know from reading my blog).

Do you know. . .

Why we need healthcare reform? What healthcare reform means for your employees and employer? How healthcare reform will change your interactions with the healthcare system? How healthcare reform may make it safer for you to get sick? Why healthcare reform will save you money?

If you can’t tell me the answers to these questions, then you need to block off 1-2 p.m. (eastern) February 5 for my webinar: Healthcare Reform 2.0: Five things you need to know to grow your business in 2013. You can also view it on demand.

And, as a “thank you” for reading this blog, I’ll give you half off the registration fee. Just use code GS12713 when you register.

 

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Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; managed care Obamacare patient-centered healthcare payment

Preparing for a (Gulp!) Colonoscopy: What It Says About Our Healthcare System

As of November 30, I am now, as my gastroenterologist puts it, 39 + 11 years old. You know what that means! So, a couple of weeks ago I called his office to make an appointment.

I would have preferred to simply make the appointment online or even e-mailed the office, but since the practice didn’t offer this, I fought my phonaphobia and punched in the numbers. Of course, I went through five prompts before getting a live person and was put on hold for a few minutes. About 10 minutes later, I finally had my appointment.

I was told to arrive at 2:30 p.m., which I dutifully did. Then the receptionist gave me a stack of paperwork to complete. And a pen. Among the information I had to provide:

• My husband’s Social Security number, since our insurance comes courtesy of his job. Not sure why this was needed, since the receptionist made a copy of my insurance card, which has all pertinent information on it. Not to mention that in this day and age of identity theft, I don’t like giving out Social Security numbers to anyone. But the last time I refused to provide a Social Security number … Continue Reading

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Would You Pay an Extra 4 Cents Per Pizza to Provide Health Insurance to Thousands?

A good friend of mine emailed me the other day to say that she is “so sick of listening to business owners whine about Obamacare.” So this blog is for her.

She was referring to the news that restaurants like Papa Johns, Applebee’s, and the parent company of Red Lobster and Olive Garden announced  they would cut employee hours, close restaurants, lay off employees, and stop hiring new employees because the Affordable Care Act (ACA) requires that companies with 50 or more employees provide health insurance.

A bit of background: Beginning in 2014, the ACA (and, for the record, I find the word “Obamacare” derogatory to one of the most important legislative acts since Medicare) requires that nearly all Americans have health insurance. Low- and moderate-income Americans will either receive coverage through Medicaid or receive government subsidies to buy health insurance through virtual marketplaces called health insurance exchanges, or to help cover the cost of employer-provided insurance. (Don’t worry, I’ll blog about those exchanges in a future post).

But the majority of health insurance in this country is provided by employers, so the ACA contains contingencies to ensure  those companies don’t suddenly drop health insurance as a benefit. Businesses with … Continue Reading

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