Sunday, September 22, 2013

Post assignment 5 for my students

It will be interesting soon to see how people (and employers) respond to the opening of the insurance exchanges soon. It is evident that even with financial help for those who really cannot afford even the cheapest plans, some people will not participate. Some people will not participate for ideological reasons; making a decision to go without medical insurance rather than becoming part of something they oppose for political, philosophical or, perhaps, for religious reasons. Others may not sign up because they don't know what is happening and may simply fail to respond, for lack of knowledge or, perhaps, lack of literacy.

http://money.cnn.com/2013/09/20/news/economy/obamacare-penalty/index.html?source=cnn_bin

To my students: do you think some hospitals and other medical care providers may pull back on providing care (beyond what they are legally obligated to provide, such as under the EMTALA law), to people and families that have decided to pay the fine rather than to buy insurance? Will it become more "ethical" or acceptable to say "no" to individuals with no insurance under the new circumstances? There are people and families who use emergency departments of hospitals as their primary care providers and do not pay for the services they continue to receive in emergency departments, by choice. Do you think the availability of the insurance exchanges will change the point at which hospitals say, "no more" to those without insurance?

18 comments:

  1. Honestly, I have had mixed emotions towards healthcare and the healthcare reform since it has become an issue. Just as the people in the article, for a long time I chose not to get health care insurance because I really didn’t need it. I very rarely get sick and when I do it is nothing to go to the doctor for. My yearly check-ups were done at the clinic, they render the exact same services as a PCP, and I paid for the services before I left, I went to the optometrists every two years and the dentist bi-annually. Doing that I maintained my health very well and I didn’t have almost $300 in premiums coming out of my every month. Once I had children I didn’t have a choice. Between maintaining shots and staying healthy in daycare, we go back and forth to the doctor’s office. Even with all this “great” coverage, I’m still left with co-pays from the doctor and prescriptions. Now that I think about it, I would be out of less money if I paid the fees and took my children to the clinic for check-ups and the convenient care when they are sick, and paid the medical bills myself. All that put together would be more affordable than my insurance premiums. Then I would pay for what I use rather than what I “might” need one day.
    Personally, I think that hospitals and medical care providers use no insurance and types of insurance as to how they provide care. Before this law even came about the “good” doctors didn’t take the uninsured and Medicaid patients. Before your vitals are taken you are asked what type of insurance you have or how you will be paying for services. I do not think it will go so far as to the emergency room and hospitals not allowing people with no insurance to receive services but many private offices already deny services so that will not be a very big change. I think that this should be an option not something that is forced upon us. Although I have insurance through my employer, I look at it like another bill. By the time I need to use the insurance I have already paid for the services twice and I am still left with a co-pay! So to sum it all up, although I am an insured American, only because of my children, I think making healthcare insurance a “this or else” situation was not a good idea while the price of living is so high. For many the fee as well as the annual penalty will take away from an already struggling household. For the most part, everyone that can afford insurance already has it.
    http://www.csmonitor.com/Business/Latest-News-Wires/2013/0922/Health-care-reform-could-launch-despite-a-federal-shutdown

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  2. According to www.cms.gov , In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented for the patient. I’m sure some hospitals and healthcare facilities have turned away patients. I’ve experienced it personally. To what level do you distinguish who you will treat based off their insurance. Does a person with United Healthcare insurance get better treatment than a person with Blue Cross Blue Shield? I see both sides. The thing is that you cannot and will not please everybody. I have medical insurance and I feel like it could be cheaper, but I know everything is costly. Any working person paying taxes is paying in some way for someone or something uninsured. Taxes are taken out of checks faithfully for Medicare, FICA, and others. I do believe a person able to receive some preventive healthcare such as bi-yearly dental cleanings and annual checkups will help tame the issue. I would rather have health insurance if it comes to me not receiving care I need, but I would not like to choose between paying my insurance premium or any other necessity like buying food, medications, or utilities. Sadly to say too many Americans face this already before health reform.
    http://youtu.be/-3I65EqlOlg

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  3. Affordable Care Act= Accessibility and Accountability. Personally I feel it's kinda already a division when it comes to health insurance. Provider's choose to see patients that are within a certain network. People that have Medicaid can't see certain doctors because the facility doesn't accept Medicaid. Some insurance companies charge you higher co-pays for seeing physician's out of network. Younger people feel insurance is too expensive so they rather not get insurance and pay the fine when they file there w-2s. I'm trying to still understand the insight of people not having insurance and not filing taxes and how will they pay their fine. I don't think emergency department will turn patients away for medical treatment because they will still be able to do certain percentage, of indigent and on write offs. With that being said my organization that I work for had an forum on health insurance exchanges and a question was asked about patient receiving services in ER with no insurance the response was "we will automatically enrolled the patient in the exchange and of course the patient will received a bill from Blue cross/BlueShield because that's the only insurance exchange carrier in our area more than likely the patient will tear the bill up but when they return back for services and they don't still have insurance we will automatically enroll them again." People face many circumstances when it comes. to having insurance. In my opinion getting people educated will be the main key in the successfulness of people acquiring insurance though health insurance exchanges.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415805/?report=classic http://healthinsurance.about.com/od/reform/a/health_exchanges.htm

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  4. I honestly am totally for the Obama health care plan. I may be a bit bias about it because I make up the percentage of Americans that are expected to make this new health care law effective. The amount of young people who sign up for insurance will greatly impact the effectiveness of the program, as healthy young adults are the least likely to use health care services. I am a young U.S. adult, who previously did not have health insurance because a contract worker, the “plans” that were offered simply wasn’t feasible for me. Furthermore, I know a lot of uninsured people that contributes to the 82% of nearly 16 million uninsured young U.S. adults that will now qualify for cost assistance or Medicaid through Obamacare's marketplaces. What I don’t understand is why are people having so many mixed emotions about previous healthcare and insurance policies, when there were so many Americans, many of them are working, who were uninsured mainly because of their inability to afford it or not have access to it at. I also feel that as Americans it should be a natural born right to have access to healthcare no matter the circumstance. I do understand the penalty given to those who doesn’t have any healthcare insurance; to me it seems to be a “no brainer” to participate in something that is offered to you, when more than likely it will be utilized. And because of this, I do feel like it will be more ethical to say no to healthcare because the new circumstances allow them to have healthcare insurance. What people don’t understand is that the millions already covered by employer insurance won't need to use the marketplace; you can remain on your current insurance. The ObamaCare offers that all new health insurance plans cover preventive services and provide new essential health benefits, this includes everything from yearly check-ups, to maternity care, to mental health, to mammograms and colonoscopies, at no out-of-pocket costs. It also includes provisions that stop insurance companies from dropping you when you are sick. I just really do get what people’s uncertainties are!!! If you already have healthcare insurance, this policy doesn't affect you and if you don’t the exchanges gives you plenty of options. Of course, everyone coverage will differ, but that’s expected because everyone income and circumstances are different!!

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    1. Thank you. Please include a relevant link with each comment and post.

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  5. First of all, what is the purpose of the health care reform? The purpose is to provide insurance for all Americans to ensure that they can be seen certain at the medical centers for what ever reason. I think the reform is good and bad to certain extinct. The good is that everyone will be covered but limited. The bad is that will everyone receive the same service with this insurance that they are being forced to get. Like Bradley said there are some medical facilities that do not take certain insurance, which kind of discourages the patients and makes them wonder why are they paying for insurance and cannot use it where they please. But you still have those people that are really not interested in healthcare insurance. Phoebe has the phoebe care card but can only use it at the hospital and certain doctor offices. The card cannot be used at Phoebe Convenience Cares which is kind of strange but its said that they was loosing money by letting them use the outside clinics with the phoebe care card. And I think that the exchanges may stop the hospitals from saying no. Because unexpectedly as of August 1, 2013, Patients without insurance have to pay a minimum of $25 up front before being seen. If they don't have it they are denied service in referred to the ER. Is it ethical or acceptable for people dealing with such circumstances? Really depending on situation.

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  6. I believe that laws such as EMTALA will help to do as much as it currently does. I don’t really see a big difference with the coming of the Affordable Care Act outside of people & businesses opting to pay the penalties. If these same people and organizations previously had no insurance but made their trips to health care facilities as needed (i.e. yearly exams or physicals) and previously have paid out of pocket, nothing changes other than seeing that penalty on their tax bills at the end of the year. I also see hospitals still doing the same thing for patients that are not properly ensured when the ACA kicks in. More than likely, they will continue doing the bare minimum; this would just enough to suffice the EMTALA. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. At that point if a hospital is unable to stabilize a patient within its capability or if the patient requests, then an appropriate transfer should be implemented to resolve the situation accordingly (Emergency medical treatment, 2012).

    I believe that, again, the answer to the question of will it become ethical or acceptable to say “no” to individuals with no insurance under the new circumstances will be that the acceptance or rejection rates will remain about the same. In reality, it is about can the patient pay for the treatment needed. If the answer is no, then refer back to Section 1867 of the Social Security Act. If it is yes, then there is no issue. I could potentially seeing most hospitals that are state ran have a department that specifically finds affordable insurance for patients who are in need of it. I believe that Phoebe Putney has something similar. This would be beneficial to all parties involved. The hospital gets its money, the patient gets treatment and healthcare enroll without worry of a fine, and the government gets to check this hospital off on the complaint checklist.

    Work Cited:
    Emergency medical treatment & labor act (emtala) In (2012). cms.gov. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/

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  7. I feel like it’s a game of monopoly when it comes to health care and insurance. Basically like a bunch of over excited kids gathered around a card table; many America’s best interest is engaged in a tall stake of monopoly. But the only difference is the winner will get more than the mere rights of bragging for a day or two. In this instance the stakes are nothing shy than control of our health care delivery system for the future. I personally am for the Obama care but like with anything there are always pros and cons. Been able to have health insurance is very important especially with the high number of people that are getting ill more and more today than they was yesterday. Without health insurance it’s really hard to get the help he or she needs when they need it. I know first hand because I had a cousin that was just recently diagnosis with Breast Cancer and she fail to go get medical attention because of the mere fact she didn’t have health insurance. And a lot of people feel the same way she did why is that? That is due to the fact many America’s lack the knowledge and are uneducated about the Obama Health Care. There are so many nay sayers in people ear saying so much negative about the health care until lots of people will opt- out of getting health care and pay the fine. To me the only thing the Obama Care is doing is to give Americans who do not get health insurance from their employers the opportunity to choose from an array of private insurance plans. The idea is to generate competition between insurers that will lead to lower premiums. The vast majority of Americans get health insurance coverage through their employers. Millions of low-income Americans qualify for Medicaid, and seniors can sign up for Medicare. But for people outside of these groups, there are few good options when it comes to health insurance. Many of these Americans pay high premiums if they are sick or middle-aged -- if they can find coverage at all. They also run the risk of purchasing policies that don't cover certain medical conditions or limit the total dollar amount of claims. That's why so many of them go without insurance altogether. http://www.kaiserhealthnews.org/stories/2013/april/25/stateline-insurance-exchanges-competition-part-2.aspx


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  8. Vontresa Stephens
    According to statistic nearly one in five American women between the ages of 18-64 does not have health insurance. This could be due to job loss, divorce or simply put cannot afford it. Under the new Obama Healthcare Plan it is to help those who are in need of healthcare. There are some of us that really are thankful for this plan while there are others such as the people we read about in the article that really opposes this plan. Well one can almost say to each his own but to whom so ever that is caught without it will be penalized. Yes, some say that they rather pay the fine and be done with it and there are others that say they cannot afford it. From my understanding, I thought that one must have health insurance and it does not matter through whom. I really hope and wish that people will take the time including myself and really search this healthcare plan out and not to be so quick to say I do not want it because I do not need it. Whether young or old, preventive treatment is important. To those who can obtain health checkups through clinics should not be fined. That does not seem fair. obamacarefacts.com.

    There may be the EMTALA law that is suppose to protect the citizens from being overlooked or not being treated in a hospital or a medical facility that does not always work. There are many laws that are supposed to protect the people but are not being up held. I do believe that hospital and medical facility are going to continue to over look and send sick people away to die on their way to another facility due to lack of health insurance. If a major credit card is not being exposed in their eyes or that plastic healthcare card is not been presented many will continue to be overlooked and sent elsewhere to expire. www.scu.edu/ethics/publications/iie/v1n4/healthy.html This really takes place now and it could become worst.

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  9. As long as American society is a capitalistic one, there will always be those who attempt to make decisions on things in the name of profit and the almighty dollar. Many healthcare professionals already engage in this type of business practice as the means to which they practice their craft. With the passage of Obamacare, I don't foresee this tactic doing anything more than becoming the status quo, meaning that healthcare providers will do no more than is required by the emergency medical protocols already in place. The larger issues are perhaps the relative unaffordability of the plan for working class Americans. It makes more financial sense for working class Americans to pay the three or four hundred dollar fine associated with the failure to secure a premium than to spend the four to five thousand yearly that the plans are suggested to cost. The alternative medical sector is perhaps reaping the most benefits as there are provisions in the act that allow for governmental funding for non proven treatments, without any room for justification for said treatments, even going as far as terming it discrimination for challenging said treatment practices. This is what I see being the biggest challenges to Obamacare and its success or failure, affordability and practicality.
    http://www.forbes.com/sites/stevensalzberg/2013/08/26/alternative-medicine-providers-show-their-greedy-side/

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    1. According to EMTALA hospitals have three main obligations; (1) to provide a medical screening examination to determine whether an emergency medical condition exists, (2) hospitals cannot delay examination and treatment to inquire about methods of payment or insurance coverage and, (3) emergency departments must post signs notifying patients and visitors of their rights to a medical screening examination and treatment. There are stiff penalties for violation of the EMTALA law.
      I strongly feel that it will become more ethical, or acceptable, to say no to individuals with no insurance under the new circumstances because, the new law makes it more accessible for everyone to obtain some form of insurance. Sure, there will be cases with exceptional circumstances but as long as the hospital is in compliance to the law they are clear to say no. I would certainly like to think that hospitals will continue to provide services to all needed individuals even if they are taxed with a nominal fee.
      In cases where people are using the emergency center as a replacement for a primary physician, this behavior needs to stop. It delays the attention that is needed for emergency cases when ER physicians are having to address routine doctor visits. Maybe referrals should be made to local physicians with a high level of importance for next day visits, if at all possible.
      I do not think that hospitals will ever get to the point of saying no more; I certainly hope not. Regardless to the medical screening and examination, physicians and nurses should always listen to the patient.
      http://www.acep.org/content.aspx?id=25936
      https://www.healthcare.gov/how-does-the-affordable-care-act-affect-me/

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