Without Medicaid Expansion, Poor Forego Health Care

Mar 2012
54,681
36,313
New Hampshire
#21
I was talking about Medicaid and Medicare....for your private insurance pain, I suggest a dose of single payer.
Sure in an ideal world single payer is best. But again how do you get the person who lives two hours away from a doctor to agree to pay taxes for healthcare he cant get to or has no access to? We have a lot of things to change first before we can address single payer. We found that out the hard way from the ACA. Getting way more doctors and healthcare professionals out there and offering clinics in rural areas. Hospital consolidation also has gone nuts and now there are fewer hospitals. Its another issue thats going to be urban v rural.
 

HCProf

Moderator
Sep 2014
27,151
16,204
USA
#22
Mr. Wahoo,

because the University of Oregon did a study and that was the conclusions they came up with.

And one of the other things the study said is emergency room visit went up, not down, as a result of Medicaid expansion.
'

The majority of patients admitted at the hospital I work have Medicaid. They have better insurance than I do. I have seen Medicaid approve procedures where my private insurance denied them. The reason they still seek care in the ER is habit. This has been going on since I became a nurse. I worked as a ER triage nurse and retrained patients on what is appropriate for the ER and what is not. I have made many appointments for Medicaid patients with the primary care physician. Keep in mind, Medicaid is a State ran program and approved services will vary from State to State. State Medicaid programs are required to perform some procedures and individual States can add to the list of services. Ohio is pretty generous as far as Medicaid.
 
Likes: bajisima
Jan 2014
16,763
4,535
California
#23
'

The majority of patients admitted at the hospital I work have Medicaid. They have better insurance than I do. I have seen Medicaid approve procedures where my private insurance denied them. The reason they still seek care in the ER is habit. This has been going on since I became a nurse. I worked as a ER triage nurse and retrained patients on what is appropriate for the ER and what is not. I have made many appointments for Medicaid patients with the primary care physician. Keep in mind, Medicaid is a State ran program and approved services will vary from State to State. State Medicaid programs are required to perform some procedures and individual States can add to the list of services. Ohio is pretty generous as far as Medicaid.
Ms. HCProf,

You hit the nail on the head. They go to the ER as force of habit because they can't be bothered for find a primary care doctors. And it's not their money they are spending, so why should they care if they clog up the already crowded ERs.
 

HCProf

Moderator
Sep 2014
27,151
16,204
USA
#24
Ms. HCProf,

You hit the nail on the head. They go to the ER as force of habit because they can't be bothered for find a primary care doctors. And it's not their money they are spending, so why should they care if they clog up the already crowded ERs.
From my experience, they don't know any better. They are not medical professionals and do not have the ability to triage a health condition. In Ohio, once they enroll they are required to choose a PCP. The insurance company helps them find a provider who practices in their local area. They tend to flood the ER's after hours or if they cannot get an appt with their PCP. No one really wants to sit in a ER for 8 hours during peak time...they are triaged in the ER based on severity of symptoms.
 
Jul 2016
5,822
4,674
BAN THE TROLL!!!!
#25
With a subject as complicated as health care, the right will do anything they can to divert away from the fact that the Declaration of Independence guarantees Americans the right to "life, liberty and the pursuit of happiness".

The Constitution?

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare and secure the Blessing of Liberty to ourselves and our posterity do ordain and establish this constitution for the United States of America.”

wel·fare
ˈwelˌfer/
noun

  1. the health, happiness, and fortunes of a person or group.
    "they don't give a damn about the welfare of their families"
    synonyms:well-being, health, comfort, security, safety, protection, prosperity, success, fortune;More
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

The simple fact is every American is entitled to health care. N0BODY, including President Obama, has claimed that Obamacare, Medicare, Medicaid, anything is the perfect answer to providing said health care.

But you know what? Nothing's perfect. Nothing works right all the time. But what we do know is that every free nation in the world, hell - even those nations that aren't free, provides health care to their people at little or no cost.

Except the United States.
 
Likes: HCProf
Jul 2016
5,822
4,674
BAN THE TROLL!!!!
#26
'

The majority of patients admitted at the hospital I work have Medicaid. They have better insurance than I do. I have seen Medicaid approve procedures where my private insurance denied them. The reason they still seek care in the ER is habit. This has been going on since I became a nurse. I worked as a ER triage nurse and retrained patients on what is appropriate for the ER and what is not. I have made many appointments for Medicaid patients with the primary care physician. Keep in mind, Medicaid is a State ran program and approved services will vary from State to State. State Medicaid programs are required to perform some procedures and individual States can add to the list of services. Ohio is pretty generous as far as Medicaid.
Which is why this conversation started off discussing Medicaid expansion and the problems associated with red states refusing to expand Medicaid to their citizens.
 

HCProf

Moderator
Sep 2014
27,151
16,204
USA
#27
Which is why this conversation started off discussing Medicaid expansion and the problems associated with red states refusing to expand Medicaid to their citizens.
States who did not expand Medicaid only hurt their safety net hospitals. Prior to the expansion in Ohio, my hospital was operating in the red and depended on Federal grants to stay open....today we have patients with reimbursement and are building and expanding the facility. The only problem, reimbursement is so low we have laid off just about as many as we hired when the expansion was first launched. We also lost a significant amount of our private insurance patients due to deductibles and elective surgery. Weight loss surgery was our cash cow but patients are reluctant to have the surgery because of the deductibles. We require half up front now from private insurance patients.
 
Likes: bajisima
Mar 2010
20,174
12,960
Indiana
#28
Around here a lot of doctors wont take Medicaid so they have no choice but to go to the ER. Its starting to get that way with Medicare as doctors are being overwhelmed with the amount of new patients beginning Medicare. We really need to figure out how to get more doctors where they are needed or we will always have a huge fight over healthcare. People in rural and poor areas will never want these healthcare solutions if they have no access. Its kind of why the ACA had more problems, sure you got insurance but either had no doctor or had to travel long distances.
And judging by what I saw in your state this summer, some of your rural areas are in desperate need of funding due to no income or sales tax for revenue, with little revenue for poor neighborhoods as all revenues is derived from local property taxes. Hence poor townships stay poor due to less revenue than the richer neighborhoods. So now you have a situation like you describe.
 
Mar 2012
54,681
36,313
New Hampshire
#29
And judging by what I saw in your state this summer, some of your rural areas are in desperate need of funding due to no income or sales tax for revenue, with little revenue for poor neighborhoods as all revenues is derived from local property taxes. Hence poor townships stay poor due to less revenue than the richer neighborhoods. So now you have a situation like you describe.
To be fair its the same in Maine and Vermont and they both have income and sales taxes. Its just the natural geography and demographics here at work. Friends of our live at the very top of Maine and they always forever had doctors in Canada. They were closer and affordable. They never had insurance for generations, but the Canadians allowed them to see their doctors and the cost was low. Now they cant do that. It disrupted many lives in the North Country, Its just that so many of our ways of thinking assume everyone lives near hospitals or doctors. Even where I live, if you get cancer or a serious health issue they will tell you to go down to Boston, thats two hours away.
 
Jul 2015
2,691
1,606
Maryland USA
#30
And the hospital is worse off getting Medicaid funding than getting nothing at all, how?
It relates to the typical level of Medicaid payment. Typically, the Medicaid payment does not cover the actual cost of providing care, most times it does not even cover the facilities fixed cost for the care provided and hospitals tend to have an extremely high fixed cost percentage. Accordingly, the hospital must eat some fixed costs and all variable costs. Medicaid recipients creates ER volume, volume that must be accommodated through staffing and other high cost items. Therefore, hospital's cannot not respond sufficiently through cost reductions. Currently, the payment shortfalls are being subsidized by commercial payers.

In the typical ER, its not just Medicaid, ER services must subsidized by the payment for other hospital services. One make ask, why was the payment for that service so high, it's because it is subsidizing the ER among other factors.
 
Likes: bajisima