(05-14-2014 07:33 PM)dawgitall Wrote: (05-14-2014 04:47 PM)Hambone10 Wrote: (05-13-2014 11:36 AM)dawgitall Wrote: You are confusing private insurance signups on the exchanges with expanded medicaid signups. There are are about 8.14 signups from the exchanges and that will probably end up being about 7-7.3 after we see how many duplicates and nonpayments there are. Then there are are over 6 million that have gained coverage through the expanded medicaid program that about half the states are offering. Most of the people that didn't get a renewal of their 2013 plan because it didn't meet ACA standards probably didn't get their new policies off the exchange, but simply took another policy offered by their agent, but I'm sure some did use the exchange, especially if the qualified for a subsidy.
And you are confusing this with success.
Many of the people 'signing up' are people who present to emergency rooms without insurance. In the past, the hospital would send their information to the state and seek reimbursement through the state programs. Now, they submit their information to the exchanges to seek coverage for them and thus reimbursement. In other words, you're only changing the method of registering and not actually creating any new registrations.... and counting this as a success.
The myth of this leading to better reimbursement and thus better care is clearly debunked in the experience of DMC San Pablo near San Francisco. It is the only hospital in the area that primarily caters to the uninsured and though they struggled prior to the ACA, the ACA SHOULD be a boon to them, right? Unfortunately, no. They are about to close. As the only heart center within about 40 miles, this means some people will die.
Isn't this precisely the sort of place that should be doing BETTER because of the ACA?
Well DMC San Pablo has been on a downward spiral since the 1990s. The parts of the ACA that would benefit a hospital in their situation have only been in place for four and a half months, that hardly seems like enough time to turn around their situation.
Spoken like a true defender. So they've been struggling since the 90's, but somehow they managed to survive until Obamacare 'fixed' their problem? Does it even make sense to you that a place that has struggled for 15 years couldn't manage to stay open for 6 months after things supposedly got BETTER for them by insuring all of their patients?
Look... I'm in this business and privy to information you aren't. This is a hospital, not a traditional business meaning there IS no 'spiral'. They are a charity hospital and they have struggled for a long time to care for all of the poor people. The 4.5 months would have been plenty of time for them to at least 'accrue' greater income (and certainly PROJECT higher income) if the ACA had resulted in increased reimbursements. Their census is up, not down.... but their reimbursements as a percentage of their costs are down even more. You can try and defend this any way you want, but the reality is right there in front of you. To deny it is to be purely playing politics with people's lives because it suits a political agenda. The CEO, while courting very liberal people in a very liberal county in a very liberal state where Obamacare is very popular specifically said that Obamacare contributed to the decline. The only people who deny this are those who want to politicize this.
Quote:We have similar problems here in NC. Our rural hospitals serve a disproportionally large number of indigent patients and struggle to keep their financial head above water. NC did not expand Medicaid and thus 318,000 that could be covered are not. The compensation hospitals would receive from Medicaid, while not as high as from private insurance would certainly have a significant impact on the bottom line.
San Pablo isn't rural. It's a few miles from San Francisco... north, not inland.
What you say would be true if the reimbursement were above the costs to deliver care, but in many instances it isn't. By codifying losses for most services and giving people who didn't have the option to travel for more elective (not elective per se, but things you can schedule and aren't urgent) who didn't have that option before... they've left these hospitals with the financially 'bad' procedures (primary care, palliative care, senior care) and allowed them to travel to a 'better' hospital for those procedures that pay better. ALL hospitals have to provide certain emergency care and that often comes with big overhead. DMC has the same overhead, but the theoretical advantage from people having insurance (the big claim of success by obamacare defenders) and thus supposedly able to pay for their care has already proven to be false... and doesn't offset the losses for services of 'choice'. Emergency, life saving healthcare has been compromised so that mothers having babies can go to a now overcrowded hospital with the same doctors and nurses, but a nicer waiting room.
'back in the day', hospitals were reimbursed a portion of their costs, so they padded the bills. More recently, the business model went to 'fee for service' meaning you got paid for what you did, subject to limits on what that particular illness should cost... i.e. if someone presents with pna, they got paid $5,000. Their job was to cure the patient for less than that. Now, the business model is going to be more like Wal-Mart, where they take losses on much of their business, to cram more 'care' into the same employee cost (which drives down quality) and hope to make it up on a few other higher margin services. As you note, in areas with high concentrations of 'government' care, this will be a massive challenge. Of course, in 5 months, it is only the already struggling hospitals that will have already failed.... but no matter how you want to look at it, things should have been BETTER at DMC than they were, and obviously they aren't.
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