Affordable Care Act

The CT Scan Cost HOW Much??

So a couple of months ago I saw my doctor about this chronic pain in my lower right abdomen. I’d had it for about a year, sometimes barely noticeable, sometimes more noticeable, and, being a medical writer, I was certain it was ovarian cancer (don’t ask my why, but I’m convinced that this is the cancer lying in wait for me, even though I have no risk factors. Medical writers are only second to med students in terms of hypochondria).

Anyway, my doctor thought it was probably gynecologic and told me to see my gyn. But he also suggested a CT scan to rule out a kidney infection or stone. Sure, I said, and off I went to radiology.

Long story short, we still don’t know why I have this sometimes pain, but it’s not that bad and I’ll just live with it (until it turns out to be something serious and it kills me [see, I told you medical writers were hypochondriacs]).

But the pain got much worse last week when I received a bill from the radiology center for $778.62. Turns out that’s what I owe after my insurance company paid it’s part of the charge. Here’s how … Continue Reading

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

Would You Walk Away from $2 Billion? Then Why Is Virginia (and 26 Other States)?

Hey, I just won the lottery! Two billion dollars! But you know what? I think I’ll just refuse it.

That, dear readers, is what my much beloved state of Virginia is prepared to do. On March 24, the General Assembly meets in a special session to consider the new budget — which is tied to expanding Medicaid. The Republican-led body has already voted against the budget because of the Medicaid requirement.

The expansion is part of the Affordable Care Act. If states expand Medicaid eligibility to those making up to 138 percent of the federal poverty level, including childless adults, the feds will pay for 100 percent of the expansion for the next five years, after which it picks up 90 percent. That’s a big bonus given that the state and the feds split the cost of traditional Medicaid.

Currently, Virginia covers children up to age 19 and pregnant women with  family incomes  up to 133 percent of the poverty level, and parents with family incomes up to 31 percent of the federal poverty level. No matter how poor you are, if you don’t have kids and you’re not pregnant, you’re out of luck.

So let’s take a look at … Continue Reading

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Affordable Care Act

Reigning in the Cost of Health Insurance, or, Why We Can’t Have Granite Countertops on a Laminate Budget

This blog comes to you courtesy of a nasty exchange on Facebook. It started with a posting about the fact that an insurance plan offered through the state exchange did not include the regional children’s hospital in its network.

This is happening around the country as insurers limit provider networks in order to keep premiums within  prescribed limits, whether those limits are mandated by the Affordable Care Act or by the employer paying for the health insurance. And it’s no secret that specialty hospitals like children’s hospitals and teaching hospitals have far higher costs than community hospitals. Reasons include the cost of training medical residents and fellows, the high percentage of Medicaid patients they see as well as the high percentage of uncompensated care they provide, and their mission to do research as well as provide patient care. They do receive additional federal and state funding to compensate — at least partly — for those expenditures, but in this day of shrinking budgets it doesn’t cover it all.

On the other hand, insurers offering policies on the exchanges must keep premiums within a certain limit based on actuarial data in their region. In addition, employers are looking for ways to … Continue Reading

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Affordable Care Act cost health insurance healthcare costs healthcare reform high-deductible health plan Obamacare

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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Affordable Care Act health insurance health insurance exchanges healthcare reform Obamacare

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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Affordable Care Act healthcare reform healthcare system; Obamacare