Our health care system is far from perfect but because of the ACA it is far better than it was.

[upaloopa]

Here is some perspective:

I work for a county Alcohol,drug and mental health services department in CA.

Before the ACA we had a large number of indigent patients in our psych hospital. Our cost per bed day is around $2,000. That is just the room and bed not treatment. By law we are not permitted to turn patients away. The money to pay for indigent patients care comes from state sales tax and vehicle license fees. It is called realignment funds. The state used to take care of mental health care but that service was realigned to the counties.

Since the ACA and since CA accepts expanded Medicaid, (Medi-Cal in CA) we have gotten reimbursed 100% for the care of indigent patients since they are new Medi-Cal patients not previously covered. It still doesn't cover all our costs (Medicaid pays 50% of billed costs to existing covered patients)

We still get the realignment funds but now since expanded medicaid we can treat more mental health and drug addicted people with our expanded budget.

We also have Medicare patients. Medicare pays a fixed fee for each type of service based on some complicated formulas. It does not cover our entire costs. Also patients have a deductable that our patients usually cannot pay so we eat that. Also there is a yearly maximum amount that Medicare pays per year. If a patient goes over that we eat it.


We need to improve the ACA not adopt Medicare for all. The ACA covers more of the costs of treatment.

[libtodeath]

1. This sounds like a contradiction

Since the ACA and since CA accepts expanded Medicaid, (Medi-Cal in CA) we have gotten reimbursed 100% for the care of indigent patients since they are new Medi-Cal patients not previously covered. It still doesn't cover all our costs (Medicaid pays 50% of billed costs to existing covered patients)

[upaloopa]

3. Previously Medicaid did not cover adult males. Now it does through expanded medcaid.

It covered children and some women and paid 50% of billable costs. The care of newly covered adult male's is reimbures 100% of medicaid billable costs in the first year, 90% in the second year

[libtodeath]

4. That is hardly fair or right to punish the others.

[upaloopa]

14. Then let's all vote out republicans. We don't vote so they get to decide.

That is where pragmatism has it over idealism.

[libtodeath]

16. Where did I say different?

Universal,single payer is what we need to be pushing for and your own posts show why.

[HumanityExperiment]

19. Indeed!

well stated!

[hobbit709]

2. So you're lucky. Think it's helped any in those states that refused the expansion?

[upaloopa]

5. That is not the fault of the ACA. Since states administer government health care they could refuse

medicare for all also. They could also refuse free in state tuition at state colleges.

[Nye Bevan]

6. It's helped people with pre-existing conditions

who previously could be turned away by insurance companies.

[hobbit709]

7. If they could afford the premiums and deductibles.

There are many without pre-existing that still can't afford it.

[upaloopa]

15. We are not lucky the patients are lucky

[Nanjeanne]

8. Absolutely. Bernie says so all the time. But unfortunately the ACA doesn't really control costs &

tax dollars in subsidies are going to already extremely profitable insurance companies who pay their CEOs and senior management exhorbitant salaries. As a tax payer - I find that a poor use of my money. I'd much rather pay it to the government for health CARE not insurance. As someone on Medicare - I love it!

[fourcents]

9. I trust someone would improve the ACA more if they don't take big pharma money.

[zipplewrath]

10. It's not controlling costs

All those costs you are "eating" are going to eat you up soon. ACA doesn't control costs. The whole point of Medicare for all/Single Payer is to get control of the costs.

[Motown_Johnny]

11. The ACA will never cover everyone, it isn't designed to.

If you agree that healthcare is a right, then replacing the ACA is the only logical policy position.

I agree it was a great improvement over what we had. I supported it from the beginning and still do now.

That doesn't mean it is the end of the journey. It is a stepping stone.

Single payer is the only logical goal, unless you want American citizens to die needlessly simply to protect corporate profits.

[upaloopa]

13. No single payer is not the only answer.

Our system can provide care to everyone if we are motivated to work toward it. Single payer raises costs by rasing taxes. We still pay but we give it a different name. It is still money out of our pockets.

Saying health care is a right is saying certain people must become health care providers to provide care coverd by the right at reimbursements we determine they should be permitted. So no it is not a right but is a goal we should strive for as a society.

[libtodeath]

17. What is your solution or proposal?

[Motown_Johnny]

18. No, it can't.

For example. How will the ACA ever cover homeless people?

In theory, they should already be covered by Medicaid. They have little or no income, this is exactly the type of person Medicaid should cover.

In reality, you need to prove that you qualify for Medicaid. People without any resources are unable to do this. Without a state issued ID and proof of income (or lack thereof) you can't prove you qualify for Medicaid.

The ACA is not designed to cover these people and there is no change to it which can be made to provide coverage for the homeless.

You may as well claim that you can alter an airplane to fly to the moon and back. You can't. It isn't designed for that. Yes, it serves a purpose and is much better than a train, but it won't ever get you to the moon.

The ACA is much better than we had but it won't ever cover everyone. Anyone who says it can is either lying or ignorant.

[upaloopa]

21. I just explained how the ACA covers homeless people in my OP

We have a clinic that serves everyone who is poor or homeless it works the same as our mental health system does.

[Motown_Johnny]

22. How to apply for Medi-Cal

https://www.healthinsurance.org/california-medicaid/

^snip^


Online on the Covered California website.

By mail: complete an application, which is available in 12 languages, and mail it to Covered California at P.O. Box 989725 West Sacramento, CA 95798-9725.

In person at a county social service office. The directory includes phone numbers for each county office if you need more information or assistance.


So you are telling me that everyone who applies is accepted? What is to keep someone who does not qualify from applying and just not providing information about income? How can you tell that some of the people you are treating are actually eligible?

If so, then we may as well have a single payer system. Why do I need to pay premiums if I can just walk in somewhere and say I need medical attention but have no identification and no income?

This sounds ripe for fraud on both ends. How does the government keep track of how many people are actually being treated?

I'm not buying it. Besides, I could just as easily have used undocumented immigrants as my example and they are not covered, not even by Medi-Cal.

https://www.healthinsurance.org/california-medicaid/

^snip^


For undocumented immigrant adults, SB10 was also introduced in 2015, and will be addressed again once the 2016 legislative session begins in January. SB10 would pick up where SB4 leaves off, allowing adults age 19 and over to enroll in Medi-Cal without regard for immigration status.

[ibegurpard]

12. No it most certainly is not

We gave taxpayer dollars to insurance companies who have continued to jack up premiums and out of pockets and REQUIRED by law that people pay the vampires...for catastrophic coverage people can't afford anyway. No cost transparency either. We simply codified our insane system and called it "reform".

[seattleite]

20. Speaking as a healthcare provider, it is NOT GOOD ENOUGH.

We need to get these horrid insurance companies OUT OF the American healthcare system. Period.