Trump Wants to get rid of Medicaid

amother

Blue

Wed, Mar 15 2017, 8:10 am

nylon wrote:

First, Medicaid is run on a state by state basis so some of rhese things depend on where you live.

Now. People clogging up ERs. There's a lot of reasons for that. I have one child on Medicaid (on top of regular group insurance) because he qualifies through a state special needs waiver. If I take him to the ER it is free. If I wanted to take him to urgent care, none of the urgent cares take Medicaid. I can afford to take him through blue cross so I do but if I didn't have it, what would I do? ER. Many Medicaid patients are seen through clinics and have difficulty getting access to urgent appointments, or can't fit it in around work hours. This is before any cultural issues where they're used to just going to the emergency room because it's what they're used to. There have been programs that sought to reduce emergency room usage. Some have been more successful than others. The thing is, it's really the hospital that's the loser, because Medicaid pays the hospital much much less than what your insurer does. The hospital is forced to eat the cost. Hospitals really do have the incentive to keep patients out of the ER.

Dental is covered for good reason and Medicaid coverage is already limited. Dental issues can be serious. Medicaid is not paying for cosmetic dentistry because your teeth are crooked. Sealants are actually a very good use of Medicaid money because they prevent cavities. You may think a little cavity is no big deal and maybe it isn't, till it turns into a root canal or an abscess. This is why sealants are recommended for all children. Medicaid also covers other things that private insurance doesn't, because it's the payer of last resort for people with disabilities. I get more coverage for therapies under Medicaid than I do under private insurance. A disabledfriend has supplemental Medicaid for her Medicare, because medicare has no cost sharing cap and her bills would be several times her income.

If one person has a whole slice of bread and the other person has half, you don't take the first person's bread away so you can feel like now you have the better deal. You give the second person more bread. The cliff between Medicaid and private insurance is a prpblem. The ACA did see that. They did provide extra subsidies to cover cost sharing for people who were middle income. But it wasn't enough. And the subsidies taper off at a point at which insurance is still a huge chunk of a family's income.

I'm a working parent who hasn't seen the dentist in 7 years. I don't have dental insurance and have more important bills to pay for first. Does it make sense that someone like myself who is paying taxes for others to have free sealants on their teeth goes without it? I can't afford to pay my own dental bills, yet I'm paying towards others.

Amarante

Wed, Mar 15 2017, 8:20 am

srbmom wrote:

Quote:

Under Trumpcare, health insurance will be unaffordable because premiums will be $16,000 per year and the maximum credit will be $4000.

I don't understand how this is any different right now? My parents who fall in this 55-65 yo age range have coverage for $1200 a month (my mom's entire salary for her part-time job goes towards healthcare, she does not get a paycheck). This is for a plan with a $10,000 deductible. Their out-of-pocket healthcare expenses for the 2016 year were $33,000 (that includes premiums, copays and co-insurance) and that is with no out-of-the-ordinary major medical issues.

At least in my state the biggest problem with the ACA was that premiums did not go up a crazy amount, but every single plan switched over to a huge deductible plan, so you are essentially paying for your insurance and then still paying out of pocket for every single healthcare expense over the year

I can't comment on your plans or options.

But you are obviously earning enough of an income so that you don't quality for any subsidy.

The illustration I gave is pointing out that many low income people in the 50 to 65 age group will not be able to afford health insurance at all because the current subsidy goes away and the tax credit is capped at $4000 which means that the amount they must pay for any health insurance would be an enormous percentage of their income.

I don't know where you live but so far as I know the exchanges must all offer plans at the Bronze, Silver, Gold and Platinum levels. The difference is that co-pays, deductibles and premiums vary. Bronze being the lowest level with the lowest premiums the deductible for a family is capped at $13,600 per year versus Platinum where there are $0 co-payments a lower deductible with total out of pocket expenses capped at $8000.

If your out of pocket expenses were indeed that high, you might have been better selecting a Gold or even Platinum plan. Only an individual can run the figures and determine what is best got them.

You are obviously not income because presumably it appears your household qualifies for no subsidy at all. Frankly if your part time job pays for medical insurance, perhaps your household would be better if you didn't work and lowered your income so that you would be eligible for a subsidy. This would be the same reason a parent with young children might not work because economically work only funds childcare.

No one is saying that the ACA doesn't need improvement. Everyone agrees (or at least those with a brain) that costs for those people on the private market who don't get subsidies are too high. It is somewhat like the situation with drugs under Medicare with the donut where drugs weren't paid for during a certain period until costs reached a huge amount. Here, the middle middle class who for whatever reason don't make the subsidy because their income is slightly too high pay high premiums.

However, the solution is not Trumpcare which really does nothing to lower costs and kicks the most vulnerable out because they simply cannot afford premiums without a subsidy or there are no longer funds for Medicaid.

Trumpcare is not driven by a desire to help the middle class. It is driven by a desire to lower taxes for the wealthiest.

I am not even sure your figures are accurate since even under the worse plan out of pocket costs are capped at $13,000 for the worst Bronze plan and let's assume that premiums without a subsidy are $1000 for the Bronze plan which is probably high - In Los Angeles which is an expensive health care market the premium for a bronze plan for two 55 year old people is approximately $700 per month which means total expenses for premiums and capped out of pocket expenses would be $22,000 which is not $33,000. And if you are capping out the maximum you would probably be better off in a plan with a lower deductible and lower co-pays. And I don't understand how two people without major medical problems can use more than $13,600 of medical care in a year. That is a HUGE amount as that means the doctor bills for two people are in excess of $1000 per month. Those are not doctor bills for people with no medical issues.

nylon

Wed, Mar 15 2017, 9:30 am

I have no idea about baby nurses, I have never heard before of medicaid paying for that except for medically fragile infants.

We pay plenty in taxes. And between my spouse and my employer, they pay $1200 a month in health insurance premiums. Those premiums have gone up every year, well before the ACA. In order to keep the premiums from skyrocketing even more, our copays and deductibles have gone up.

I'm not sorry I have one kid on Medicaid. It pays for things that, despite all those premiums and payments, his insurance doesn't cover. We could make everyone's insurance cover all that, so kids like him wouldn't need Medicaid, and everyone's premiums can go up more.

I'm not sorry kids on Medicaid get dental care. Dental care should not be a luxury. I wish health insurance covered dental, and not with the piddly caps. I wish health insurance covered people's hearing aids. And vision exams? They discover glaucoma, diabetic retinopathy, and other diseases. I have to get an exam every year. (in fact, my health insurance would pay for the health part of the exam if I went to an ophthalmologist, since I'm diabetic. But I wear glasses anyway, so I just do it as part of my private glasses exam.)

And, to be honest, dental care is so hard to get for most Medicaid patients (few dentists accept it in many areas) and kids already represent a low proportion of Medicaid spending. Being mad about sealants is about emotions, not economics. What costs money are people with chronic illnesses and disabilities, and long term care. If they cut dental care from Medicaid, it would make no difference except to make you feel better, and some kid could get an abscessed tooth and wind up in the ER. There was a famous case where a 12yo died as a result of not getting dental care.

amother

Saddlebrown

Wed, Mar 15 2017, 9:36 am

amother wrote:

Or how about medicaid paying for the taxi to get to and from the doctor? Or paying for tylenol and motrin and other OTC medications? Or kids that come to the doctor for throat cultures because their sibling has strep and Mom just wants to make sure this one doesn't have even though there are no symptoms? None of these are things that someone for paying for their health insurance has the luxury of having. No, its not ok that medicaid patients get way more services that those that pay through the roof for their health insurance.

ectomorph

Wed, Mar 15 2017, 9:43 am

nylon wrote:

I have no idea about baby nurses, I have never heard before of medicaid paying for that except for medically fragile infants.
No
We pay plenty in taxes. And between my spouse and my employer, they pay $1200 a month in health insurance premiums. Those premiums have gone up every year, well before the ACA. In order to keep the premiums from skyrocketing even more, our copays and deductibles have gone up.

I'm not sorry I have one kid on Medicaid. It pays for things that, despite all those premiums and payments, his insurance doesn't cover. We could make everyone's insurance cover all that, so kids like him wouldn't need Medicaid, and everyone's premiums can go up more.

I'm not sorry kids on Medicaid get dental care. Dental care should not be a luxury. I wish health insurance covered dental, and not with the piddly caps. I wish health insurance covered people's hearing aids. And vision exams? They discover glaucoma, diabetic retinopathy, and other diseases. I have to get an exam every year. (in fact, my health insurance would pay for the health part of the exam if I went to an ophthalmologist, since I'm diabetic. But I wear glasses anyway, so I just do it as part of my private glasses exam.)

And, to be honest, dental care is so hard to get for most Medicaid patients (few dentists accept it in many areas) and kids already represent a low proportion of Medicaid spending. Being mad about sealants is about emotions, not economics. What costs money are people with chronic illnesses and disabilities, and long term care. If they cut dental care from Medicaid, it would make no difference except to make you feel better, and some kid could get an abscessed tooth and wind up in the ER. There was a famous case where a 12yo died as a result of not getting dental care.

I had a medically fragile baby. I paid for my own baby nurse. What if I couldn't have afforded it? Which could very easily be the case. This is not what Medicaid is for.

I am happy for people to have strep tests on Medicaid. But you can't conflate that with luxuries.

It's like food stamps. I don't want anyone to starve. I'm even happy that they should have a healthy diet. But if my neighbor on food stamps is eating steak and salmon every night, and I am not on food stamps and cannot afford fleishig during the week, I don't want my taxes paying for it.

amother

Scarlet

Wed, Mar 15 2017, 9:46 am

nylon wrote:

I hope I would also not be sorry if my kids were on medicaid. The sealant vision and hearing tests are thing s they do at a doctor that reg insurance won't pay for. I am thank God on pretty good insurance and we have dental insurance as well that covers a yearly check up. Although I did go through two years or so between being on medicaid till I was able to afford my own care where we were not covered. This is not about me now. We are lucky enough to get these things through my husband's work. Many are not. For many many dental is a luxury. If you think that's an ignorant approach to dental care then I'm glad you never had to choose between the food on your table and going to the dentist. A library is not the same. Everyone has equal access no matter the finances. Besides that many do get upset when they build a state of the art library and higher everyone's taxes. Nobody's asking for state of the art. A library is totally different what a red herring argument. The money from a library comes from property taxes. The way medicaid is set up now is unsustainable, lots of money gets wasted and people who could use it aren't getting covered. It is a crutch to society. I know of people who can't take another job because the extra 5000 dollars will kick them off medicaid. People who ask their employers not to give them a raise. This is not a good system.

amother

Cyan

Wed, Mar 15 2017, 9:47 am

Oy saddlebrown I am not talking about people who take advantage. Lol, some people have nothing to do with their time so they go for just in case 🤣 rofl. This is so sad and funny at the same time. Anyway there are most peop,e that don't waste their time on that. And no I don't call anyone to take me to the doctor.

There are probably a handful of those weirdos. Focus on the healthcare itself. The access to the specialized care my kids need. If you feel the system is wrong then modify it. Don't do away with it totally!

For goodness sake that's all I'm saying. reread my posts and get a clear understanding. No one will gain from this new trumpcare act. It will be disasterous!

[youtube]American healthcare act last week tonight with john
Oliver[/youtube]

Listen to this and if you don't get it or have more issues then I'm done arguing, time will help you understand. Good luck to all of the people like me that don't fraud the system and honestly don't know what I'll do.

It's sad that because there are those that fraud the system others pay a very heavy price for that. But clearly the rich have no inkling what the poor feel like and trump is one of them.

Scrabble123

Wed, Mar 15 2017, 9:50 am

I'm appalled at the amount of ignorance on this thread. I pay taxes and pay for health insurance. There have been times when I have paid separately for dental insurance and times when I paid out of pocket to go to the dentist. Regardless, I have no issue with Medicaid paying for dental care, vision care, and even taxis in some areas to take individuals to their appointments.

Furthermore, Medicaid does not tolerate individuals going to the ER for trivial issues like a cold or to get a pregnancy test. Generally, individuals in the ER with such complaints are there either because they have more severe symptoms or are afraid it could be something worse or because they are uninsured.

As another poster pointed out, it's not dental care and taxis which are causing high expenses, but rather services for which we'd all agree individuals are entitled to. The U.S. needs healthcare reform; however, suggesting that we stop providing children with important dental care (and dental care is not a luxury), aiding seniors, transporting individuals to appointments they are unable to otherwise attend, etc. is asinine and ignorant.

SixOfWands

Wed, Mar 15 2017, 10:12 am

amother wrote:

Wow! Number one flouride sealant on babies is not necessary it is a luxury! As is dental care! Which is the reason I don't get those things! If you are poor you don't get things! Grow up! Work harder, go back to college, let every able bodied man and woman work to earn their keep! And if not pay the consequences. Yes don't die in the street but get the bare minimum of care not a luxury plan which is what your plan seems like to me. Beautiful that dental care is beneficial but if you can't afford it you brush your teeth three times a day and get checked out if something bothers you. Cost is so high because many are getting served for very cheap (by medicaid) so others foot the bill.

You do not have a peice of bread. You are being given a peice of bread because you are too poor to buy your own. But our country cannot afford to give out bread anymore. So people should grow up and start getting serious about finding a way to pay for their own bread.

I'm sorry if this sounds harsh but seriously you think everything should be handed to you on a silver platter? Did it ever occur to you the thousands of dollars the government has given you? Did it ever occur to you that money does not grow on trees and instead of just taking that money like it's owed to you to try your hardest hardest to pay your own way?

Minimum wage in NYC is higher than most places -- $11 an hour. Working a 40-hour week at minimum wage gets you $22,880 a year. Which is below the poverty line for a family of 4. If a couple both work full time at minimum wage, that's $45,760. Survivable in NYC, but still a big struggle. These are people who ARE working. They're just not working at jobs that pay enough. But they are still positions needed in our society.

So, what are you willing to have happen to these people. Are you willing to say to someone, "I'm sorry, but you can't afford medical treatment; your baby is going to die." I have a BIL who has serious medical issues and as a result cannot work. Are you willing to tell him, "I'm sorry, but your life is no longer worth it to us, I suggest you make your final arrangements." The next time someone posts here about her financial issues, and pregnancy, post what you just said, under your real name (and I mean real, not a nym) -- "you should have thought about that a few months ago; tough luck."

But costs are not so high because of Medicaid and Medicare. They're so high because the medical industry is for-profit, and doctors and hospitals and the insurance industry like making money.

Quote:

A Salon analysis of regulatory filings found that the top five health insurers — UnitedHealth, Anthem, Aetna, Humana and Cigna — have doled out nearly $30 billion in stock buybacks and dividends from 2013 to 2015. (The Supreme Court ruled in favor of the Affordable Care Act in 2012.)

Meanwhile, the increase in customers that these health insurers received under ACA has helped raise the stock prices of the top five insurers — some 80 percent for Anthem and 165 percent for Aetna since the high court ruled on June 28, 2012 that Obamacare was constitutional.

While Americans continue to fork out more money, insurers are doing great.

On Thursday [October 27, 2016], Aetna reported $734 million in profit on $15.8 billion in revenue for the three months that ended Sept. 30.

amother

Teal

Wed, Mar 15 2017, 10:19 am

amother wrote:

most people in the hospital with the sniffles are uninsured not individuals with Medicaid.

Where I live, those uninsured fall into two main categories: people who qualify for Medicaid (but don't have because seriously mentally ill, don't want the hassle etc) or who are illegally here.
What is the real difference between me paying for their care through Medicaid or through higher hospital bills? (And longer lines and fewer services available.... So that's lost wages, time etc. we pay either way!!) I pay for both of their care anyways! They here illegally never pay the bills- as I was told from someone in the business, they give fake names, addresses, contact info. No way to trace them...but when I walk in, I have to give all this information! Before DH could have critical emergency surgery, they took a CC from me, made me give all information.... They wouldn't give me consent forms until I did! (I couldn't find my wallet in the craziness...)

I get why we have to treat anyone who comes into the ER and that is only reasonable, but there needs to be limits on government programs and a tapering off- you can earn more but you lose a certain amount of benefits so that people are easily transitioned off. Maybe a maximum of free Dr visits and then a small copay.

youngishbear

Wed, Mar 15 2017, 10:19 am

For those obsessed with Medicaid fraud, it boils down to either fraud by people who are ineligible for it in the first place, or misuse by those eligible (let's leave unethical medical professionals out of the discussion for a moment.)

I offer my unprofessional and unlearned opinion that instead of raging at the ways poor people struggle to survive and perhaps misuse a system meant to help them, take a better look at those who have enough to live on but are still never satisfied. I am willing to bet you will find much more federal money wasted on those upper percenters.

Here is just one lovely example:

https://www.washingtonpost.com.....6902a

I am reminded of the story (perhaps a Dubno mashal?) of the time there was a famine in the forest, and the animals held a conference to determine the source of their affliction. One by one the animals confessed to sins - the lion devoured a list of innocent creatures, the fox stole from the farmer, etc. Each was exonerated. When the little lamb admitted to nibbling a stray piece of straw that had fallen off the farmer's wagon, the animals pounced on her and pronounced her guilty of causing the terrible famine with her sin.

My point is not to excuse, condone, or normalize fraud. It shouldn't happen, and we should think of measures to stop it. But don't kid yourself that that's where the money goes.

amother

Teal

Wed, Mar 15 2017, 10:39 am

The problem it seems that people don't understand is that everything adds up. You want transportation- well, in my area there are low income bus passes. Disabled transportation at reduced rates. Plus there are waivers for no cost options. Why does Medicaid need to pay for taxis as well?
You want vision, dental care (and not just the basics...) too?
Unlimited Dr visits so parents take all their kids in for a checkup for free when only one is sick? I only bring the one I am concerned about as I have a $35 copay. Plus co insurance if any tests were done. Like I said, I didn't get medication I needed because I couldn't afford it. I suffered. Yes I lived, but why do I have to suffer when everyone else I am paying for gets it all (and more) for free?

Stop saying "dental is not why it's so expensive..." Because everything adds up. Transportation, dental, vision, comprehensive medical...
They deserve it like I deserve it. But I don't get it.

youngishbear

Wed, Mar 15 2017, 10:43 am

amother wrote:

The truth is you deserve to get it too. But please understand that people on these programs often have no backup plan for emergencies. If you desperately need a root canal you will probably somehow find the money, but the single mom on medicaid will not. Preventing major dental issues by treating minor ones or protecting against them in the first place is cheaper for society in the long run.

SixOfWands

Wed, Mar 15 2017, 10:50 am

amother wrote:

Actually, Medicaid doesn't have to pay for taxis. It pays for non-emergency medical transportation that has to be appropriate, but can include buses.

A strep test costs about $30, and its pretty standard to test all kids when one has it. To avoid a second visit.

The real question isn't why Medicaid pays for these basic services. Its why we live in a country where you can't afford them.

amother

Teal

Wed, Mar 15 2017, 10:57 am

youngishbear wrote:

Don't assume.
When DH had his accident we had to use the hospitals charity program where it was embarrassing- them analyzing our bank statements, income, tax returns, asking about bills and debts....

I have helped friends fill our Medicaid paperwork, went with them to the appointment and it wasn't so intense. Or demeaning.
So no, we won't get the $$ from somewhere. When we don't have it we don't have it. We went to charity.