Posted by JasonR86 (9714 posts) -

As always, you can leave comments asking me anything including about what I bring up. But remember, I'm not the be-all end-all on this topic. Even if I think I am.

So what's up with Obama-care, affordable care, whatever?

Well, that's hard to say. I know what the new healthcare is supposed to be; affordable healthcare for everyone and whatnot. But I work primarily with people who are on Medicaid which is state funded health care. Now I'm no expert on how exactly this system works but I know enough for my job and just enough to be dangerous. Here's my take on Medicaid generally speaking; it is affordable health care. From what I understand the new healthcare is supposed to be more all encompassing and cheaper but a lot of my client's get the Medicaid for free so you can't get much cheaper then that. So, basically, the new healthcare seems more all-encompassing. I think.

Ok. But, we still don't know how it'll work in real, paying agencies terms. As far as I know no one in my clinic, including our financial people, have heard how it works. We don't really know anything really about how it is supposed to pay us. As it stands now all of our established and new clients have Medicaid, or 'other' insurance (we'll discuss that in a second), and still do. But we also heard that the new healthcare will either change or be an adjunct to medicaid. But we don't know how that really works either just that something is going to happen at some point. So we are taking on clients and keeping clients and doing therapy work without knowing if next week or month or whatever we'll have to let them go because they don't have benefits or their benefits don't cover our therapy. For that fact, we don't know how much the new healthcare will cover our sessions (basically how much money do we get in return for services rendered) or even if our services will be covered. Or if chemical dependency will be covered. We don't really know anything! Which makes this whole change real frustrating to plan for both financially and therapeutically. Do we prepare client's for ending sessions? Do we handle things as if nothing will change because, for our purposes, they won't? WHO KNOWS!

Wait, paid for services rendered?

Yep. We get paid for our work. And how much we get paid depends on things like insurance. So I work for an agency that is non-profit and serves more lower-income individuals. In our circumstance, we get paid the most from medicaid insurance. Private insurance is next (which will cover in a second). Then medicare if it is covered by our agency (I'll cover that later too). Then sliding fee scale which is waaaaaay less then medicaid. Basically, the lowest end on our sliding fee scare results in about 10% money back of what we get from medicaid. So as a businesses, even a non-profit businesses, need to keep things like payroll, budget, etc. on the mind. We have financial goals we have to keep to stay open. So we can only take so much medicare, private pay, and sliding fee scale. Which is an issue because we may have to implement things like a wait-list that can last for months on end. There are more too. Keep reading.

So lets pretend the new healthcare system doesn't exist. Which insurance is better; medicaid, medicare, or private insurance?

Well, all have their benefits and drawbacks. Medicare is the exception really for mental healthcare. There are types of medicare that cover counseling and more that cover psychiatry. But those types of medicare are rare. So we have very few medicare clients.

Medicaid pays kid. It pays us well. So we like medicaid. Plus there are systems in place where I live that makes getting into services when you have medicaid pretty simple. Which I think is pretty cool. With medicaid there's no fuss, no muss, no legwork. Here's the drawback; as you improve, if your getting medicaid for free, you'll lose that medicaid. Basically, medicaid is conceived as a way to help people to better themselves when they are low so they can improve, rejoin the workforce, and live productive and happy lives. Then medicaid benefits go away (which not only cover mental health but dental, medical, eye-care, etc.). Most jobs these clients would get would be low paying and wouldn't have insurance (which hopefully the new healthcare system would fix). So clients are conditioned to be unhealthy to have more. It makes therapy really frustrating sometimes because you're helping someone so they can improve and consequently have less in the hopes that way later they'll have more. It's a hard arrangement.

Private insurance is nice because there's freedom. Client's dictate their insurance fully as long as they pay. Pay more and you get more. It's like other insurances. Pay more for car insurance you get better coverage. Same thing with medical, mental health, dental, etc. insurance. It is also there for you when you get better (you know, as long as you keep paying for it). The drawback is that you have to do leg work.

Here's how it works. Clients call their insurance companies and they give clients a list of providers. Some of these providers are in private practice and some are in agencies. Private providers are nice because there are only the providers to deal with and no politics (for lack of a better term). The problem being they only have so many hours to fill with sessions and can only take so many clients. An agency has a ton of therapists with all sorts of hours to be filled with therapy sessions. Unless their are full with clients (which happens).

The problem with agencies is that, for private insurance, likely only a few therapists are on the boards of a few insurance companies and they need to be on the board of those companies to be reimbursed for services rendered. But then you have to make sure those therapists have free slots for clients. Or that the agencies can be paid for their services by the private insurance (which isn't a ton) while still meeting their budget. It's all a lot of work for everyone.

It all sounds confusing and frustrating.

It is.

So the new healthcare will fix it?

Cross your fingers. I have a feeling though that it'll be nearly exactly the same with just different, new headaches to deal with. Call me a cynic I guess.

That's it for this blog. Ask away dudes. And correct me if I'm wrong because there's a good change I might be in some of this information. It's all very complicated.

#1 Edited by SathingtonWaltz (2053 posts) -

All I know is that my hours have been cut substantially because of this new law, and I'm now a part-time employee making less money(I used to be full-time).

#2 Posted by JasonR86 (9714 posts) -

All I know is that my hours have been cut substantially because of this new law, and I'm now a part-time employee making less money(I used to be full-time).

Sorry dude.

#3 Posted by TruthTellah (9153 posts) -

Oh sh*t, @jasonr86 gettin all hot topics on us now.

Man, I liked Mental Health From a Biased Source before it went all Headline News, ya dig? Shiiiii...

........

*cough*

Thanks for your thoughts on it, Jason. Those are similar to the impressions I've gotten from other medical professionals.

#4 Posted by JasonR86 (9714 posts) -

Oh sh*t, @jasonr86 gettin all hot topics on us now.

Man, I liked Mental Health From a Biased Source before it went all Headline News, ya dig? Shiiiii...

........

*cough*

Thanks for your thoughts on it, Jason. Those are similar to the impressions I've gotten from other medical professionals.

I know right? I've gotten a lot of questions about it from clients so I figured I'd bring it up here. I like how the end result of my thoughts on it are basically, "dude I don't know."

#5 Posted by TruthTellah (9153 posts) -

@jasonr86 said:

@truthtellah said:

Oh sh*t, @jasonr86 gettin all hot topics on us now.

Man, I liked Mental Health From a Biased Source before it went all Headline News, ya dig? Shiiiii...

........

*cough*

Thanks for your thoughts on it, Jason. Those are similar to the impressions I've gotten from other medical professionals.

I know right? I've gotten a lot of questions about it from clients so I figured I'd bring it up here. I like how the end result of my thoughts on it are basically, "dude I don't know."

Yeah, my primary physician was pretty against it for a long time, but since it got upheld in court and the implementation started coming along, his opinion is more along the lines of, "I don't know, but I hope it'll actually do some good."

#6 Edited by Aetheldod (3594 posts) -

Let me tell you if it works like our social security (in Mexico) you kinda fucked.... let me explain:

All workers have to have the social security paid off by their employer , when they get sick they need to get a consultation date on IMSS (instituto Mexicano de seguridad social / Mexican Institute of Social Security) or like we like to call it el importa madre su salud (the they dont give a fuck about your health), in case you wonder , you nedd to get a consultation date with a doctor (which is totally random , it could happen that day or in a week etc.) You get to your examination by doctores who dont like being there as much and many undergrads doing their social work. So if you are lucky you can get a proper care , if not you had to insist on getting proper care (my grandsma´s housekeeper had to wait for months for a operation that she really needed to get done (my uncle had to pull some strings so she could have a better date which was on December 25 of all days). Also the IMSS is way understaffed , has little to not enough medicines for people , some clinics even refuse to attend people for lack of hospital beds (theres been cases of pregnant mothers having to give bith in the strreeets because they refuse to attend them) Also the IMSS is heavilly undermined because the feds dont give it enough money also the other wrong part is that IMSS also does work like the USA´s social security as they give out pensions and the like. Its a big mess if you ask me.

Or you can go the sane route which is to go to private practice (not as expensive as in the USA but still not cheap enough) and if you have insurance the better. To be honest how you describe Obama care sounds similar to this and its not good enough.

#7 Edited by Wrighteous86 (3782 posts) -

@sathingtonwaltz said:

All I know is that my hours have been cut substantially because of this new law, and I'm now a part-time employee making less money(I used to be full-time).

I'm sorry that your employer is an asshole, but odds are that's not really Obamacare's fault. That's just their scapegoat. Despite media attention, the national trend is that more employers are offering their part-time workers full-time hours to be covered better on health insurance.

Sure, some smaller employers won't be able to do that, but the Walmarts and Papa Johns of the world are just trying to make another buck off their employees, and found the perfect opportunity to do so while pointing their finger elsewhere.

#8 Posted by JasonR86 (9714 posts) -

@sathingtonwaltz said:

All I know is that my hours have been cut substantially because of this new law, and I'm now a part-time employee making less money(I used to be full-time).

I'm sorry that your employer is an asshole, but odds are that's not really Obamacare's fault. That's just their scapegoat. Despite media attention, the national trend is that more employers are offering their part-time workers full-time hours to be covered better on health insurance.

Sure, some smaller employers won't be able to do that, but the Walmarts and Papa Johns of the world are just trying to make another buck off their employees, and found the perfect opportunity to do so while pointing their finger elsewhere.

I hadn't heard that. I remember when I hadn't started my career and was just doing jobs the full-time jobs I had I had to fight for. Most companies wanted to give me just up to 30 hours or so so that I couldn't qualify for benefits and their bottom line was lower. But that was like 5-6-7 something years ago so maybe things I have changed. But when you're in the business of making as much money as possible I don't know why it would.

#9 Posted by Colourful_Hippie (4369 posts) -

Thanks, Obama?

#10 Posted by Video_Game_King (36272 posts) -

Damn it! There was one question I know I wanted to ask you should this feature come around again, but I absolutely cannot remember it. DAMN MY POOR MEMORY!

#11 Posted by GaspoweR (3066 posts) -

Yeah, this blog post pretty much confirms what I know from someone who works with insurance is that nobody (just exaggerating here) really knows and there is still a lot that isn't completely clear at this point since there are still glitches to be worked out, etc. and there have also been reports of scam artists taking advantage of this by trying to fool people that they are going to help them navigate the system and then getting paid for it in return.

A relative of mine who works in a clinic within a hospital did mention that her co-workers, particularly therapists working in the pediatric setting (e.g. speech, OT, PT) expressed concerns on how this might adversely affect how services would be rendered to patients.


Thanks for posting again, good sir.

#12 Posted by JasonR86 (9714 posts) -

@gaspower:

I'm a little worried it won't cover issues that are typically hard to treat and don't make money. Long term issues in particular. So chemical dependency, autistic spectrum disorders (which is already under supported), and more chronic mental disorders like schizophrenia. Those typically require consistent, sometimes yearly care and don't make agencies much money mostly because the prognosis is poor so it isn't well covered by insurance. Might have a hard time picturing how that gets better and can very easily picture how that gets worse.

@video_game_king:

Hurry up and remember!

@colourful_hippie:

Sure?

@aetheldod:

I'm a little worried about those issues as well. In terms of mental health, we already have to many clients and not enough pay or room for more therapists. Add in that most inpatient hospitals don't have any open beds you're left wondering if, for mental health in particular, is a more all encompassing insurance plan the answer. Will we have more money to grow clinics to staff and pay more therapists? My gut says no. My gut says we'll have to see all clients for fewer sessions and cross our fingers that what we do in a short time is beneficial. By short I'm saying like 10 sessions. 10 sessions is nothing. Most of clients go for 20-30 sessions if not more. We can barely be introduced in 10 sessions.

#13 Edited by FourWude (2261 posts) -

Yeah but who pays when the loonies run the asylum?

#14 Edited by believer258 (11949 posts) -

@jasonr86: Is there any evidence that Obamacare might do some good here? It seems terribly unclear exactly what this will do for anybody, except force everybody to pay up.

@fourwude said:

Yeah but who pays when the loonies run the asylum?

Do you mind keeping your jokes in Animasta's thread, where things have already gone crazy? They don't have much place here, and I'll gladly go flagging like a snitch if you can't muster up some level of respectability at some point. The US government might not be able to but a smart person like you ought to be able to.

#15 Edited by JasonR86 (9714 posts) -

@believer258:

There's really not enough information to say. In principle it seems good but in practice it seems very similar to Medicaid. So I really don't know. There's too much uncertainty for me. Like how are we going to pay it and will lack of funds impact what treatments we can do. We just don't know yet.

#16 Posted by Video_Game_King (36272 posts) -

I think I remember my question now:

Does the concept of a mental health check-up exist on any level? Like a physical check-up where you cough and let somebody feel your testicles?

#17 Edited by JasonR86 (9714 posts) -

@video_game_king:

Kinda. An assessment is essentially a check up but I practice it isn't used that way. If people are getting an assessment they likely will start services. Most aren't told, 'You're good. See ya.'

#18 Posted by Kidavenger (3569 posts) -

When I read the prices they are expecting people in the US to pay for "affordable Medical care" I'm kind of surprised, but I haven't really seen what is covered:

Are prescription drugs covered? cancer medicine? birth control? Viagra?

Psychiatrist/Psychologist treatments are covered? is there a limit?

Does it included preventative stuff like dental/massage/chiropractic?

Is it 100% coverage or is there a co-pay?

People like to say that Canada has free healthcare, but it's really just hospital/emergency room stuff, most full time employed people up here have additional coverage through their employer that costs a minimum of $200(individual) or $400(family) per month for dental and drug coverage and ranges from 80-50% coverage with annual limits that can vary pretty wildly from place to place .

If you are unemployed, you would have no coverage other than emergency/hospital in Canada.

#19 Posted by Colourful_Hippie (4369 posts) -

When I read the prices they are expecting people in the US to pay for "affordable Medical care" I'm kind of surprised, but I haven't really seen what is covered:

Are prescription drugs covered? cancer medicine? birth control? Viagra?

Psychiatrist/Psychologist treatments are covered? is there a limit?

Does it included preventative stuff like dental/massage/chiropractic?

Is it 100% coverage or is there a co-pay?

People like to say that Canada has free healthcare, but it's really just hospital/emergency room stuff, most full time employed people up here have additional coverage through their employer that costs a minimum of $200(individual) or $400(family) per month for dental and drug coverage and ranges from 80-50% coverage with annual limits that can vary pretty wildly from place to place .

If you are unemployed, you would have no coverage other than emergency/hospital in Canada.

One of the big problems here is that those types of incidents causes quite a lot of US citizens to go bankrupt, having something like that alone would be awesome.

#20 Posted by Kidavenger (3569 posts) -

@colourful_hippie:

My brother blacked out last year on vacation in Florida, we brought him to the hospital, they looked at him for an hour, couldn't figure out what was wrong, and he started to feel fine so we left, a week later we got a $16,000 bill in the mail, they did nothing. Real glad we got the travel insurance, that was a real eye opener of how completely fucked your medical system is down there.

It's definitely better up here, but it's not the free ride it's often portrayed as; that monthly fee you guys are being forced to pay is just coming off our pay cheque in the form of taxes and it's fairly limited in it's basic coverage.

#21 Edited by Colourful_Hippie (4369 posts) -

@colourful_hippie:

It's definitely better up here, but it's not the free ride it's often portrayed as; that monthly fee you guys are being forced to pay is just coming off our pay cheque in the form of taxes and it's fairly limited in it's basic coverage.

The whole "free ride" talk is mostly spouted by propaganda rhetoric whenever comparison's to Canada's healthcare system are made

#22 Posted by SathingtonWaltz (2053 posts) -

@sathingtonwaltz said:

All I know is that my hours have been cut substantially because of this new law, and I'm now a part-time employee making less money(I used to be full-time).

I'm sorry that your employer is an asshole, but odds are that's not really Obamacare's fault. That's just their scapegoat. Despite media attention, the national trend is that more employers are offering their part-time workers full-time hours to be covered better on health insurance.

Sure, some smaller employers won't be able to do that, but the Walmarts and Papa Johns of the world are just trying to make another buck off their employees, and found the perfect opportunity to do so while pointing their finger elsewhere.

Both the law and the companies are to blame. The law is poorly written in that it allows for such a simple exploit.

#23 Posted by Chaser324 (6587 posts) -

As someone with a "pre-existing condition", I'm in favor of these new healthcare laws. For the time being, I'm covered by my employer, but if I ever needed to get individual insurance, it's nice to know that insurance companies wouldn't be able to totally deny me coverage just because of a health condition that is 20+ years in my past and has zero impact on my current well being.

Moderator
#24 Posted by JasonR86 (9714 posts) -

As someone with a "pre-existing condition", I'm in favor of these new healthcare laws. For the time being, I'm covered by my employer, but if I ever needed to get individual insurance, it's nice to know that insurance companies wouldn't be able to totally deny me coverage just because of a health condition that is 20+ years in my past and has zero impact on my current well being.

Yeah, that is an issue that this will address. That doesn't really apply for mental health though but for medical it helps for sure.