Now that we are in 2013 and many of the Affordable Health Care Act provisions and welfare reform are in place what do you think? Do you think the new laws are making it easier for people to get health care or more difficult?
So far, my experience is things are going to be more difficult for a large portion of people. On the surface, it sounds great: Easier access to health care for those with pre-existing conditions, lower out-of-pocket costs for preventative visits, the opportunity for small businesses and those without insurance to participate in health insurance “exchanges” to get lower premiums and better coverage, the elimination of spending caps, etc.
Those things are great, but they don’t necessarily make health care “more affordable”. For instance: Do you think insurance companies, which are for-profit companies, are going to take a hit on preventative visits? If the client pays less for the visit, will premiums increase? Or will there be more micro managing?
This year our health insurance company changed because my husband’s employer selected a different company to cover its group. We were told there would be no changes to the coverage, but there have been MULTIPLE changes to how the coverage works. One of the prescriptions my husband has been taking for more than 10 years is now listed on the “specialty” list and we do not have the option to fill the prescription at the pharmacy located three blocks from our house. My husband had to contact the specialist who prescribed the medication, who then had to contact a specific pharmacy clearinghouse to give the OK for the prescription and tell them why my husband had to have it, and then the prescription, which we used to get in three-months supply, was shipped out. This particular prescription has to be maintained at a specific temperature or it goes bad, but we can not even go to one of pharmacy’s retail stores. It has to come through the clearinghouse. My husband may need to go through this process every month.
That is just one of the changes that has taken our health care from managed care to micro-managed care, which concerns me. It feels like we are moving away from a system where doctors actually have the ability to treat patients with what works to a system where either insurance companies or the government makes the decisions about our health care treatment. People who have no idea who the patient is or how his/her body reacts to drugs or treatment will be determining what is best.
That is scary for me. I am so sensitive to drugs that I missed work for three days taking one pill that was prescribed for me by an emergency room doctor. My body reacted terribly to it. I had those hives that grow in lumps. I would get a huge lump on my face and when it receded, a new lump would grow on my arm. When that one receded, a lump would grow somewhere else on my body. It was AWFUL!
Anyway, things like anesthetics stay in my system for extended periods of time, sometimes causing emergency room visits because of being so sick. And some people do not believe me. I had one anesthesiologist tell me my prior reaction had to be because of the pain pills I took after the surgery, even though I told him I could not take prescribed pain pills.
I am afraid of prescriptions that I am not familiar with, so to have someone who doesn’t know how my body reacts telling me which prescriptions I can or cannot have does not appeal to me.
That aside, micro managing health care does not reduce costs or make it more affordable for anyone. There are more doctor’s visits, more paperwork, more people to do the paperwork, and the list goes on. And who pays for all that? If it is government, we do. If it is private insurance companies, we do through our premiums. If the premiums are subsidized by the government, we pay for that, too. So you tell me how this is more affordable!
The changes in health care for seniors and medicare also have hit home. The red tape and hoops needed to jump through have increased for some things for my mother. Her situation hasn’t changed, but we have to prove that she still has the same disability she has had her entire life, which includes more visits to the doctors and physical therapists, which means more cost for everyone.
The medicare changes also are affecting medical supply companies. As of the first of January, many small companies have closed their doors because the majority of their business was through medicare and the hoops are getting too hard and costly to jump through. Though I’m not real clear on how it works, it sounds like the competitive bidding process for providing medical supply items to medicare recipients also may put some companies out of business because of selecting one provider for the entire country and making it unlawful for companies to sell outright to those who qualify for medicare. All I know for sure, is the new laws have a lot of companies scrambling, and a lot of clients wondering how their needs are going to get met in the future.
What does our health care look like in the future? I know we need health care reform, but in my opinion, we are going to need health care reform of the health care reform.
When talking about Medicare and the recent changes, I am hearing some disturbing information. One is the fact that federal law forbids a company to repossess a wheelchair that has been delivered to a Medicare or Medical Assistance client. I don’t know how long that law has been on the books, and it makes sense, but the changes in Medicare are making it harder on small medical supply companies. What I am hearing is that Medicare will say a power wheelchair is a “medical necessity” for the client, so the chair is delivered, and a few months later, the claim is audited and Medicare takes the money back because of simple things like the doctor’s signature is unreadable. That leaves the company holding the bag!
I understand not being able to take the legs out from under someone, and I really appreciate that. But Medicare appears to be turning into a system like the Canadian banking system. I sold a car to a Canadian, who paid me by check through his hometown bank. When I went to my bank here in Minnesota, I was told that three months down the line, he could choose to put a stop payment on the check and I would have to return the money because of how the Canadian banking system works.
Paying for something and then pulling the money makes sense in very few instances. Instances of fraud, or people double dipping. But to pay for an $11,000 wheelchair and then take the money back because of something like an unreadable signature, or not having a description for “progression of the disease” when the disease isn’t progressive, is wrong! If the signature isn’t clear enough for their liking, that should be caught before the chair is paid for so it can be corrected.
And who pays for the auditors who look over the claims and determine whether or not the money should be taken back? We do through our Medicare taxes. I wonder how much of that money actually makes it past administration cost to client care.
Our Medicare tax dollars are already lacking funds to pay for the care we need as seniors. It is estimated that a couple pays about $100,000 over their lifetime toward Medicare needs, but spends more than $300,000, creating an unsustainable funding deficit. Adding more administrative costs does not close that gap, though withdrawing paid-out funds does. Maybe reducing benefits from the front end is the answer instead of taking the money back, or increasing the Medicare taxes.
We need to look at Medicare, who it is set up to help, how it works and what needs to be done to balance the budget. We also need to figure out ways to detect fraud that do not harm those who need the services and those who provide them.