Obamacare, Healthcare, etc.

**Tyche** · 2012-06-30 15:12

Originally Posted by Acturus

Quality based medicine is ALREADY coming down from Medicare, starting next year. That's independent of the ACA.

I'm talking about what's specifically in the ACA regarding quality based care payouts to individual providers starting Jan 1 2015.

**Acturus** · 2012-06-30 16:50

Originally Posted by Tyche

I'm talking about what's specifically in the ACA regarding quality based care payouts to individual providers starting Jan 1 2015.

My understanding was that it was a repeat of what Medicare already intended to do with both physicians and hospitals. They already track quality measures for hospitals, nursing homes, and home health providers.

My hospital system has been preparing for quality "pay for performance" anyway. We haven't been talking ACA.

**hey** · 2012-06-30 16:54

Originally Posted by SwampdonkeyPLD

It's only great b/c you think it is. There's no tangible economic benefit/efficiency. There's complete difference b/w people losing their jobs b/c the car came along, and people losing their jobs b/c the govt. artificially destroyed them.

No, it would be great even if i was too stupid to see that it is great.

**Tyche** · 2012-06-30 20:38

Originally Posted by Acturus

My understanding was that it was a repeat of what Medicare already intended to do with both physicians and hospitals. They already track quality measures for hospitals, nursing homes, and home health providers.

My hospital system has been preparing for quality "pay for performance" anyway. We haven't been talking ACA.

It does already apply to hospitals and is independent of ACA. It extends to independent providers in 2015. I tried to state that in that first post but it was terse. I had just finished a 12 hour shift, sorry :/. We lost $500,000 in medical payments from CMS last fiscal year. Projected 1.5 million this year. Were one of the top 6% of hospitals in quality in the nation too.

**kuronosan** · 2012-06-30 22:42

Originally Posted by Tyche

It does already apply to hospitals and is independent of ACA. It extends to independent providers in 2015. I tried to state that in that first post but it was terse. I had just finished a 12 hour shift, sorry :/. We lost $500,000 in medical payments from CMS last fiscal year. Projected 1.5 million this year. Were one of the top 6% of hospitals in quality in the nation too.

Honestly I believe our reimbursements will go up because of higher numbers of clients and patients coming in that can actually pay and have insurance. It's proportional. I think most of us are worried that the top dogs who run health care like a pure business and not like a service will cut jobs and/or pay (they already did at my place) using the bill and/or insurance as an excuse for loss of profit. We're pretty sure that the higher-ups didn't take a cut at all.

**Tyche** · 2012-06-30 23:06

Originally Posted by kuronosan

Honestly I believe our reimbursements will go up because of higher numbers of clients and patients coming in that can actually pay and have insurance. It's proportional. I think most of us are worried that the top dogs who run health care like a pure business and not like a service will cut jobs and/or pay (they already did at my place) using the bill and/or insurance as an excuse for loss of profit. We're pretty sure that the higher-ups didn't take a cut at all.

I think gross reimbursements/revenue will increase, but so will losses. 500k wasn't a net, it was just the total in care in which we weren't reimbursed. We still had substantial overall revenue. I think our gross revenue was something like 1.09 billion (about 60% of which was from medicaind/medicare/state plans), so $500,000 isn't that damn much. I mean, it is, but I don't think there's a hospital that's going to have 100% reimbursements.

Alarial · 2012-07-01 00:23

Can anybody answer this. Companies with a certain number of employees must provide health insurance now. What if a number of those employees qualify for medicaid through the medicaid expansion ( up to 133% poverty level)? Does that employee get medicaid, or do they have to take the insurance through their company?

**BaneTheBrawler** · 2012-07-01 00:49

Pretty sure the employee gets to pick, just as long as they have some coverage. But I'm just guessing.

**Tyche** · 2012-07-01 01:07

Under 133% of poverty level qualifies for Medicaid. 133%-400% of poverty level will get subsidies for the exchange if they cannot get insurance through their employer.

**guartz** · 2012-07-01 02:23

Originally Posted by SwampdonkeyPLD

Neither were health insurers until now, I guess that could change.

But let me put it this way:

Buy health insurance or pay a fine - unconstitional.

Buy health insurance or pay a tax - constitutional.

What's the difference?

Since nobody could answer that question, I shall.

They are able to exercise Sovereign-Right if they call it a tax.

http://legal-dictionary.thefreedicti...overeign+right

That is to say, if it's a fee, then it's contestable. If it's a tax, then it is not.

**guartz** · 2012-07-01 09:37

Anybody into this can answer a few questions?

By the way, was the final figure given for the penalty?

and what qualifies as health insurance, is it major medical only? can I get limited medical? Does it have to be a specific deductible etc?

**Ragnus** · 2012-07-01 09:40

Under MA's plan, most HMOs did the job. There were some cases of outside of the the state health plans I was offered that didn't meet requirements.

The tax is $600 or 2.5% of yearly income. Whichever is greater.

**Yugl** · 2012-07-01 09:42

I believe the last figure will be $2,085 or 2.5% (Whichever is higher). The starting is about $285 and the number between them is some odd amount.

Edit: What the hell was I remembering then.

Ok, so

Not obtaining insurance in 2014 will cost a person $95 or 1% of his or her income, whichever is higher. In 2015, it's $325, or 2% of income. For families, the penalty will be $285 per household or 1% of income, whichever is greater. By 2016, it goes up to $2,085 per family or 2.5% of income. Penalties will rise each year.

http://www.cnn.com/2012/06/28/politi...ned/index.html

**Salodin** · 2012-07-01 09:59

I'm assuming this is per month, and not year? How much is healthcare if you don't go through your employer generally?

**Jonny** · 2012-07-01 10:05

It's per year

**Salodin** · 2012-07-01 10:07

Originally Posted by Jonny

It's per year

Wow. That's just...that's not even as bad as I thought it was, and people were making it out to be. Especially if the gov is paying for most of the insurance you'd get any ways...

**Jonny** · 2012-07-01 10:11

Yeah I already pay for my own health insurance since I am self employed, So this bill doesn't really affect me unless it lowers my premiums.

**Tyche** · 2012-07-01 10:17

Originally Posted by Jonny

Yeah I already pay for my own health insurance since I am self employed, So this bill doesn't really affect me unless it lowers my premiums.

Depends on how much you make. You may qualify for a subsidy.

Also, Rick Scott says Florida will not participate in PPACA

http://www.tampabay.com/blogs/the-bu...mply-obamacare

**Sepukku** · 2012-07-01 10:18

Originally Posted by Salodin

Wow. That's just...that's not even as bad as I thought it was, and people were making it out to be. Especially if the gov is paying for most of the insurance you'd get any ways...

The bills not that bad, really, its just so much money has been spent from the Right-Wing to paint it as awful. A significant chunk of the "I dont like this bill" votes are actually thinking it doesn't reform ENOUGH, not outright "I hate the direction we're going in" votes. But it is a first step in the right direction; as Americans we're just playing catch-up with the rest of the 1st world countries.

**Jonny** · 2012-07-01 10:21

That would be fantastic but if not doesn't bother me since I would rather be with then without.

Living in AZ I wouldn't doubt our governor said the same.

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