Today (1 Jan 2014) ACA's requirement for everyone - except a massive list of exceptions - is required to have health insurance.  However I can say with 100% certainty that they don't.

I work for an EMS service in KY for my civilian job.  Today I had 60% of my patients inform me they did not have insurance.  Reason?  They could not afford it.  But under ACA they could afford it.

More after the squiggle.

Each patient who did not have insurance now qualified for Medicaid under the Expansion program.  (yes, KY is one of the many enlightened Democrat controlled States…even if we do have Mitch and Rand to embarrass us in the Senate)

Not one of them knew they now qualified for this.  One even told me that because they worked for a national company that puts grilled meat on bread, they could not get Medicaid since "the President exempted the company from the law".

So I gave them the phone number of the KYnet enrollment helpers. (1-855-4kynect (459-6328) for those who want to know)  This annoyed my partner who has opinions that he only shares on Facebook about low income earners…while ignoring his low income earnings.

After I gave the number to our second patient he got grumpy and said "sure, just get this  person set up to suck money from the tax payer."

I pointed out that this person was going to "suck money from the tax payer" either way, not having insurance means the Ambulance and Hospital bill was going to be unpaid and fall on the tax payers of the County.  But if they got enrolled in the Medicaid program, the bill will be lower because of pre-negoitated rates and is going to be picked up by the Federal Government while helping this person get better health and will need us less.

I had to show him the numbers: (these are ruff numbers, not 100%, just from what we got in an inservice in June)

Cost of an Advanced Life Support Ambulance transport to the Emergency Department: $1,070.  Medicaid repayment rate: $750 + $5 per mile.  (no that is not bad, it is also not due to what I make - just over $180 a 12 hour shift with out overtime, my partner is getting around $120 a shift)

If the person has Medicaid two things will happen, the lower rate is charged, and the bill is paid.  

If they don't have insurance the following happens: a bill for more money is sent to the address. it gets ignored, another bill is sent, then another.  At this point the County turns the bill over to a collection agent who sends a bill and reports the non-payment to the credit agencies.  They also submit a request to garnish any state or local income tax return.  They also call, visit, "encourage" the person to pay anything, even over time while tacking on interest and fees.  In the end, the bill stays out there trying to be collected, but the Ambulance and Hospital have written off getting paid, marked it up as a loss and charged everyone else more to cover that cost.

The person who had the bill but no insurance, now has a bad credit report and is less likely to qualify for a job or training program.  They have only received short term treatment for their issue and are likely to be back on the phone calling 911 because they don't have a doctor.

The area I ride is low income, so I meet a disproportionate number of uninsured each shift.  But when 6 out of 10 transports to the Hospital are highly likely to go unpaid, that is a lot.  Right now $6,400 in one day's medical bills goes unpaid, a big cost to the tax payer.  But if Medicaid covered it at the lower cost, tax payers are "covering" $1,920 in the short run.

I'm going to keep giving out the number, I know it will annoy my partner and I know most won't bother to call it.  I'm realistic enough having worked this area for a while to know a vast majority who say they can't get health insurance can't because they won't fill out the forms or make the call.  We watch them abuse their bodies, engage in self-destructive behaviors, make repeated bad choices, and use the system to avoid the responsibility for their actions/choices.

(sorry, but there are 1.3 million people in our Metro coverage, if i'm able to fill out your name, birth day, address and a short medical history, you have been calling 911 too often.  And when it is for the same reason over and over, you're not taking care of yourself.  Does not mean I'm not going to respond, does not mean i'm not going to give you the best care possible, but it does mean you are making bad choices.)

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