Trump’s planned changes to the “Affordable” Care Act

I started this rant on Facebook after reading this Business Insider post:Trump says he’s willing to keep 2 key parts of Obamacare that he couldn’t repeal anyway it got too involved and detailed for there so I put it on WordPress.

Of course he isn’t going to totally repeal it. All the big business insurance companies love it. Here I’m making these numbers up. Further in the post I looked up actual amounts from the website for me. They get $100/mo premiums from you (plus more from the government as a subsidy), then they get to make you cover $2000 of your own money before they have to pay anything except for a once a year wellness exam (which runs them ~$60 because they have a pre-negotiated contract with the doctor). UnitedHealth made $66 billion PROFIT in 2015.
So if you’re a relatively healthy individual with only about 2 sick visits a year, they get to pocket $1140 a year on you. Plus you have to pay for your 2 sick visits out of pocket because you haven’t met your deductible. Granted you may get a discount on your doctor’s office for having insurance. For example, my hospital visit for pneumonia & severe sepsis with a 3 day stay… total $13,000… Discount for having insurance $10,000… insurance company paid $1,000… my responsibility $2,000. And that was 3 years ago.
The 2 points he’s going to keep:
1. Keep your kids on your health insurance to age 26. This is keeping kids covered through college/grad school. Too many people like this option to repeal it. Yes, even all the republicans. When I was looking at Med school one of the issues I was going to have to face is I would be kicked off my parent’s insurance when I turned 21. I would be in school until I was 24 or 25.
2. Pre-existing conditions have to be covered. Too many people like this. This was HUGE. Got congestive heart failure? Diabetes? Better hope your factory that provides you with your health insurance doesn’t close. Because before the ACA insurances could say we’ll cover you except for conditions related to disease X because that’s a pre-existing condition. I’d met people who couldn’t leave a job for a better job because either their or a dependent’s health conditions would not be covered.
He wants to be able to put back in lifetime maximums. Organ transplant patients usually hit lifetime maximum. Currently insurances still have to cover you no matter if you’re in the hospital a year or not. I can think of 2 transplant patients I cared for that were in the hospital over a year and most of that in ICU. Considering, 9 years ago I knew someone who after 3 months in ICU/Step-down owed the hospital over $2 million, think about what over a year in ICU would cost… This cuts into insurance companies profits. And you’ll see those donation jars & GoFundMe campaigns come out again for people who need transplants.
He’s probably going to defund the state exchanges and Medicaid and Medicare programs. I don’t get involved in the financial side of healthcare much because I work with the critically ill. You have to take care of them regardless of their ability to pay. So be prepared for all those out of pocket rates to skyrocket.
I just checked my 2017 costs on if I couldn’t pick up coverage at the new place of work. The cheapest monthly premium (I make too much for a subsidy.) is $299.49 and that has a $6,200 deductible. It covers 0 of my 2 physicians I currently see and only 1 of my 2 medications. So for best coverage I’d need to change both of my doctors and one of my medications. Oh & after I meet that $6,200 deductible? It only pays 40% until the $6,550 out of pocket maximum is met. So for $3,593.88 a year I get ONE preventive wellness doctor visit until I spend $6,200 more out of pocket. Or I can pay the government ~$1,400 (2.5% of yearly income) for the tax, Pay my doctor $150 for my yearly well exam and save $2000. That also does not  cover any dental and dental procedures do not count toward the deductible.

No. Obamacare isn’t killing the insurance industry. In fact WellCare’s stock is up 1,410% since 2009.Cigna 1,113%. Humana 1,010%. UnitedHealth 814%. Aetna 628%. These are FOR PROFIT companies. I just think healthcare no longer needs to be for profit for anything life-sustaining. Diabetes, just go to your doctor, figure out your prescription dosage, get your insulin, take it, you live. Breast augmentation or sex change surgery is elective. You can continue to live with the wrong gender. I do not mind elective/cosmetic procedures incurring profit.

Big case in point with the lifesaving vs. profit, Medicare BY LAW cannot negotiate drug prices. $1100 per dose of chemotherapy. Medicare has to pay it. Even with a $500 per dose chemo agent showing the same outcome results. In fact chemo was 42% of Medicare’s budget in 2014. Medicare cannot tell your physician which chemo you should have. But the reimbursement rate to physician’s offices & outpatient clinics is currently a percentage of the cost of the medication. So a $10 medication would see the clinic making ~$0.60. An equivalent drug with the same outcomes that cost $1,000 would make the clinic ~$60. Medicare is looking at ways to change this so that clinics would look at using cheaper medications with equivalent outcomes.

One lifesaving medication I have to have is an EpiPen because of an allergen that I might get exposure to at work. In the UK a similar device costs $68. Here in the US the current cost is $600+. EpiPen has ~94% of the market share in the US. The CEO of the company has been called before Congress to be questioned about the price. Honestly my plan for when they expire is to get some needles & pre-fill 2 syringes with the right amount of Epinephrine (~$5 per vial). Someone can just push the plunger manually. That’s over 1/3 of a take home paycheck for me that I wouldn’t have to give those corporate goblins.

Enough ranting. I am going to shut up now.


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