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Wilbert Jones helps local residents sign up for the Affordable Care Act, widely referred to as

As many as 4.3 million people have gained Medicaid coverage (as of the end of February) because of expansion, and another nearly 1.6 million found out they were eligible under previous Medicaid rules and are now enrolled. That's a total of 5.87 million people covered by Medicaid alone, according to Charles Gaba's ongoing count. Meanwhile, however, Republicans and big-moneyed GOP backers like the Koch brothers are fighting tooth and nail to make sure that not one more person get that coverage.

Paul Waldman at the Plum Line talks about that fight.

Most cruelly, many of the states that have refused to accept the Medicaid expansion are those where Medicaid benefits are most stingy to begin with. Each state sets its own eligibility levels, and not too surprisingly, states run by Republicans tend to set them extremely low. So for instance, if you’re a single parent in Alabama with two kids and you earn a princely $3,221 a year, the state considers you too wealthy to get Medicaid. In Texas, which has more people living without health insurance than any other state, that figure is $3,737. Millions of the working poor could have gotten coverage from Medicaid through the expansion, but their state legislators and governors quite literally believe that it's better for a poor person to have no health coverage at all than to get coverage from the government.

By one analysis, 5.2 million Americans who could have gotten Medicaid if their states had accepted the expansion will remain uninsured. And if you asked those people in a poll whether Obamacare had helped them, they’d quite reasonably say no.

That's just how Republicans want it to be. In fact, they're banking on it for 2014. The more people Obamacare helps, the harder it is for them to run against it. And running against Obamacare is pretty much all they got at this point.

And that is what Democratic campaigns should be focusing on every single day between now and November 4. They need to be reaching out to those people who are being left out to tell them why they aren't being helped by Obamacare. They need to be registering those people to vote, and they need to be getting those people to the polls. Here is a ready-made issue for Democrats to use to turn the Obamacare tables on Republicans, an issue that shows in stark relief just how callow and cruel Republican policies are.

Originally posted to Joan McCarter on Tue Mar 18, 2014 at 03:13 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (36+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Tue Mar 18, 2014 at 03:13:48 PM PDT

  •  GOP = Great at Obstruction Party (2+ / 0-)
    Recommended by:
    Onomastic, Lencialoo

    It seems that, as you say, the Republicans have nothing to run on or against other than the ACA.

    If only honest discussion, rather than talking point politics ruled the day, the Left would win every time. Our ideas are better and they actually help people (not in the 1% anyway).

    I love the idea of painting the GOP as obstructionist in every way.

    Or we could start re-purposing children's books to make our points.

    "when the going gets weird, the weird turn pro"

    by gravlax on Tue Mar 18, 2014 at 03:24:49 PM PDT

  •  Well I am now enrolled.... (1+ / 0-)
    Recommended by:
    LI Mike Medicaid due to the ACA.  I still haven't figured out if this is better or worse that the ICHIP cobra extention program that I was forced off of due to the ACA.  I suspect better because even if it turns out to be crap I am not paying the $320 a month, increased to $520 a month due to the ACA, for a $5000 an incident deductible state run program.

    I did have to change doctors as my old doctor did not take Medicaid and I had a little trouble finding a qualified doctor that did take it.  Well now I got a new doctor that seems ok if a bit hurried in a doc-in-a-box sort of place run by the hospital closest to me.  I ended up in the emergency room last Monday due to sciatica, I think there is more to it than that but that is another story, and follow up tests resulted in new diabeties meds that is causing some dyspepsia.  Oh well.  I will see how good it is when the bills start coming in.

    Hopefully this will fall under the something is better than nothing category.  Still a good job like I had years ago would be ideal.  But that ship has sailed, to India.

    We Glory in war, in the shedding of human blood. What fools we are.

    by delver rootnose on Tue Mar 18, 2014 at 03:57:51 PM PDT

    •  "when the bills start coming in"? (4+ / 0-)

      If you're on Medicaid, you shouldn't see any bills coming in. Seriously. Some states charge up to a $3 copay on drugs, but other than that, your cost should be zero.

      What you may want to do is use some of the money you were spending on premiums on services that Medicaid doesn't cover. Back pain often responds well to exercise programs, for example, that aren't "medical" enough to be covered. Where I am the YMCA has a sliding scale membership, so that's worth checking out.

      •  I certainly hope you are.... (0+ / 0-)

        ...correct. I live in Illinois and I get the feeling there is two tiers of Medicaid.  The traditional Medicaid granted for people who are disabled per SS and those who got it recently due to ACA as some doctors took the one but not the other and the plans you were allowed to select on the website differed and were more numerous for the disabled.  And there was some confusing information about deductibles.  The meds were indeed only $2 for generic, more for name brand and there was a limited formulary.  I have yet to get the program's welcome book and confusion, and delay seems the order of the day with an almost universal excuse for even impolite behavior of 'we are just so overloaded with new applicants' like they didn't have time to prepare.  Hell they could hire me if they need help but much of it is run out of Springfield.

        Of course switching doctors is only a minor problem but it rather strange that he took one type of Medicaid patient and not the other and several other doctors I was looking at were listed as available but then when you tried to select them they were either not taking new patients or had already met some quota.  I don't know if this quota was set by thier practice/hospital or the ACA program.  I did not talk to any one person who was an expert.  And the website was either no information or so much information you could not figure out if it applied to you or not.   For example when I first signed up I was routed through the offices and website for Illinois All kids program and I am a 48 year old single male with no kids then I think it did a quick circuit through the department on aging.  I think they are pulling resources from other agencies to handle the initial rush.  I hope it stabilizes in time.

        We Glory in war, in the shedding of human blood. What fools we are.

        by delver rootnose on Wed Mar 19, 2014 at 06:15:37 AM PDT

        [ Parent ]

        •  You are right about people on SS being different (1+ / 0-)
          Recommended by:

          Most people on SS disability qualify for Medicare, but if they were not eligible for Medicaid too, before the expansion, then it would seem like a two tiered system.

          I worked for a company that handled the Oregon Health Plan,  (Oregon' s name for Medicaid) and most people who were on SS disability and had Medicare,  we're automatically eligible for Medicaid as well. If that was they case, Medicaid became their Medicare supplemental plan, and covered all costs that Medicare doesn't.  

          I'm not working in insurance anymore,  but from what I've been told, those states that took the expansion now extend that to seniors and others with SS disability,  whose incomes were slightly too high to qualify before. For states that didn't allow Medicaid money to be used for SS disability recipients before, then almost all of them. If the plans work together, then Medicare is the primary insurance company, with Medicaid as the secondary insurance company. Many more doctor's take Medicare than Medicaid,  in most areas of the country, and the way they decide which one you are, is based on your primary insurance company.

          I hope this helped some, but if you have questions,  I really suggest that you talk to one of the navigators, in your community.

          I also would be fair to my former coworkers if I didn't point out that every insurance company that handles Medicaid contracts is constantly being caught off guard by enrollments,  when legislatures change the rules. Many states don't allow companies to hire in anticipation of need. The margins for managing the plans make it so that nonprofits are usually best equipped to run them well, but often the new contracts that come with eligibility changes, comes a week or two before the new implementation.  No matter how much pre screening of applicants you do, so still have to wait for the contract to be signed, before you can hire and train people. Unfortunately,  it usually takes at least a month for a new customer service trainee to be ready, and even longer for enrollment counselors and claims processors. Managing even a relatively small change that covered an additional 3500 people in our service area had us behind on most things for 3-4 months.

    •  Check regs on medicaid asset repo after your (0+ / 0-)


      For many who now qualify for medicaid, the asset "relief" under ACA sounds good, and if you need medicaid now it may be your only choice. However, upon death, the State must seek reimbursement by going after your assets such as your home. Not good news for the kids and it insures that any financial help they were expecting upon your death may be sucked up, up and away into the maws of the government.

      It wasn’t the moonlight, holiday-season euphoria or family pressure that made Sofia Prins and Gary Balhorn, both 62, suddenly decide to get married.

      It was the fine print.

      As fine print is wont to do, it had buried itself in a long form — Balhorn’s application for free health insurance through the expanded state Medicaid program. As the paperwork lay on the dining-room table in Port Townsend, Prins began reading.

      She was shocked: If you’re 55 or over, Medicaid can come back after you’re dead and bill your estate for ordinary health-care expenses.

      The way Prins saw it, that meant health insurance via Medicaid is hardly “free” for Washington residents 55 or older. It’s a loan, one whose payback requirements aren’t well advertised. And it penalizes people who, despite having a low income, have managed to keep a home or some savings they hope to pass to heirs, Prins said.

      •  Paying back Medicare/Medicaid is not because (3+ / 0-)

        of Obamacare.  This has been on the books since 1993.

        "Congress passed an omnibus budget bill that required states to recover the expense of long-term care and related costs for deceased Medicaid recipients 55 or older. The 1993 federal law also gave states the option to recover all other Medicaid expenses.

        The Affordable Care Act did nothing to change existing federal law. It did, however, expand the number of people who are eligible for Medicaid, so there will be more people on Medicaid between the ages of 55 and 65, and, therefore, potentially more estates on the hook for Medicaid expenses after the beneficiary dies."

        source:  January 10, 2014

        •  yes. True. However, asset regs have been loosened (0+ / 0-)

          to allow the expansion under the ACA. The net result will be a massive house cleaning of assets from deceased middle class and poor who were "house rich" and income poor. That will help insure their children have an even more difficult time staying afloat.

          Surely you didn't think was an accident?

          Surely you aren't under the impression that the kind, compassionate for profit health INSURANCE industry wrote and lobbied a bill through congress that would reduce their profits?

          Everybody on wall st. loves the law.

          This isn't rocket science. It is pure cold hearted capitalism with sugar on top.

          •  Medicare/Medicaid is financed primarily (2+ / 0-)
            Recommended by:
            JuliathePoet, kfunk937

            by the government and the state in which you live.  When someone has to enter long-term care and can't pay for it, when their assets  are depleted, Medicaid chips in.

            Depending upon how long you remain in care iwhat your insurance company pays (if anything), won't be enough.It is your government and state that essentially foots the bill; they need to be reimbursed.  This is taxpayers money.

            Now, I agree with you, this is a sad state of affairs for too many.  Long Term care is very expensive.  Not everyone can afford to take out a policy.  Most of us just hope it won't be in the cards.

            The positive is that people will get the end-of-life care they need, the negative is that it is not free, the piper must be paid.

            My brother was in this situation.  He had no assets to pay for his hospice care at the end of his life, he had Medicare, but that doesn't pay for long term nursing care.  He had to go on Medi-Cal (Medicaid in Califortnia).  He was cared for until the end which came, lucky for him, 3 months later.  

            The only way to pay for long term care would be if we went to a entirely socialist form of health care.  Higher taxes for everyone, but care from cradle to the grave.  

            Perhaps one day we will, but at this time in our history and because of our culture, a health care system which includes insurance companies will exist.  At least the ACA now regulates them so they can't screw us the way they did before Obamacare.

          •  Agree with Artmrss Medicaid has nothing to do with (2+ / 0-)
            Recommended by:
            JuliathePoet, kfunk937

            insurance companies. Whether these rules are fair or not, the fact is that state is giving free medical care and they want to re-coup their costs somehow. But it only applies for people older than 55.

            I do not think that Medicaid is an ideal solution but it is the best thing for now for those who cannot afford insurance. A single payer system would probably be better all-around.

      •  Can't you just declare more income? (0+ / 0-)

        For many people getting medicaid, an income just a few hundred or a few thousand dollars more would mean they could qualify for a subsidy that makes exchange insurance almost free. Many people have a little cash side work that is not declared--babysitting, selling on ebay, a craft fair,  a couple yard sales,  helping some friends move, etc. Just declare it. At the limit  to get from medicaid to private insurance, income is so low that you are unlikely to owe additional tax and if you do, an extra $100 to keep your house is worth it.

  •  If you are eligible for Medicaid there should be (2+ / 0-)
    Recommended by:
    gravlax, AJayne

    no bills. Some states have Medicaid co-pays, some have spend-down requirements (spending X dollars to spend down to the eligibility level), some have specific site requirements (e.g., chronic hypertension should not be treated in an ER).

    You should read the fine print for your state.

    •  Yes, The unHealthy Indiana Plan (HIP) (1+ / 0-)
      Recommended by:
      joe from Lowell

      requires the poor to pay out to get care, strictly limits the number that can enroll, and does other harm. Mike Pence just kicked 10,000 people off it and told them to go on the Exchanges, all the while pretending that covering about 40,000 out of the 600,000 who should be eligible is Medicaid expansion.

      You guys are so un-hip it's a wonder your bums don't fall off.
      Zaphod Beeblebrox, HHGTTG

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Tue Mar 18, 2014 at 11:51:02 PM PDT

      [ Parent ]

  •  this past session , AZ GOP legislature (1+ / 0-)
    Recommended by:
    Sherri in TX

    trying to put a lifetime 5 year cap on medicaid eligibility for individuals

    trying to include a work requirement (they just don't  get that you can be working or self employed and still qualify)

    trying to require monthly income reporting (again, screws people who have irregular income)

    trying to add copays of $200 for er visit ,for example, to , of course , adult recipients who are above poverty level but below the new 138% level

    and all ,this  despite the fact that the FEDS are paying 100% for the first  few years and 90% after that


  •  i also qualified for it (1+ / 0-)
    Recommended by:
    delver rootnose

    and i am still nervous about it. no one seems to quite know how to handle a lot of the new recipients.

    for example, like others, i am self employed and my income varies WILDLY from month to month. i can receive a half years' pay one month and zero the next few months, and all of it is unpredictable

    the state also uses TOTAL GROSS receipts as the income , instead of ADJUSTED GROSS INCOME like the feds do , so there is a huge discrepancy and disconnect between the state and the fed. (for me,  gross receipts  reflects an income nearly twice my AGI) someone has got to get to them and fix this. so far even the advocates roll their eyes and have no idea how to handle this fact.

    no one can tell me what happens if i get 9 months into the year,  and get a big project and bump up into a higher income level either... does it reflect retroactively for the year? will the state want payback?or can i get into the  Fed marketplace at that point? and what if it falls back again? Again, the navigators and advocates have no idea.

    so it is nerve wracking not having any idea what kind of bumpy ride this will be, though i am  very, very happy to be a guinea pig in the interests of the ACA.

    also , i qualified as of Jan 1, but the insurance company has yet to issue me a packet or a card. when i call they tell me i am 'ahead of the game ' by asking....

    ?????? it is now late March.the insurance company  needs 3 months to get me a card??????????

    even so , i've found a new doc, (i wanted to change docs, my old one was incompetent) and i will  have better coverage including  some dental, and saving money as well.

    my goal is not to stay on medicaid, but to build my income back to where it was before the crash of 2008, then i will gladly say adios to medicaid.

    but I need it now. have put off going to the doctor  since 2008, though got totally screwed for several thousand dollars of useless tests the one time i did go, with my no good  cheap insurance before the ACA

    •  This should be a Diary (0+ / 0-)

      and possibly a story in your local media.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Tue Mar 18, 2014 at 11:52:29 PM PDT

      [ Parent ]

    •  You're right about the income thing (2+ / 0-)
      Recommended by:
      ferg, JrCrone

      If I'd been designing it, I would have made the "Medicaid expansion" just the lowest tier on the ACA subsidy ladder. That way, if your income is lower or higher than you estimated, it would just affect the amount of your subsidy (which you will adjust on your 2014 taxes, a year from now), rather than people flipping back and forth between ACA eligibility and Medicaid eligibility, and some people falling in the gap due to the different ways the two systems treat "income."

      And basing anything on gross receipts is just nuts for small business owners or self-employed individuals. Even a Republican state legislator should be able to deal with that issue and how unfair it is.

      •  yes it is a huge flaw (0+ / 0-)

        i wonder if it was designed that way to act as a carrot for the states? i'm sure there was some reasoning behind it, but it makes no sense ..perhaps they weren't figuring that the states would be so recalcitrant, especially when they were being offered 110% federal dollars for each expanded medicaid recipient.

      •  Naming matters (1+ / 0-)
        Recommended by:

        The Democrats have been truthfully descriptive. By having the lowest tier been simply an "invisible" Medicaid expansion, which, of course, would be federally subsidized, that would have been an extra step necessary to demonize it for the Republicans.

        Furthermore, it would be nice if you didn't have to figure the subsidy for yourself on your taxes.

        I believe the Red States have been recalcitrant for reasons entirely separate from the money. The Democrats thought it would work because of "enlightened self-interest" without remembering how remarkably unenlightened and downright medieval the Republicans actually are.

        Darling, you didn't use canned salmon, did you?

        by JrCrone on Wed Mar 19, 2014 at 07:21:52 PM PDT

        [ Parent ]

    •  Essential you get either an invoice or (0+ / 0-)

      an insurance card from whatever company says they are covering you.  No matter what someone on the phone tells you, if you have not paid a premium by the end of March, you have zero proof of coverage.  

      If you cannot get the insurance company to deal with you ASAP, call the (not email) the people at and tell them what has happened.  Your situation re not actually getting anything from the insurance company is happening all over the country.

      My friend finally got his coverage cleared after repeated calls for nearly two months AND only after the insurance company tried  to say he was not covered because he had not paid, when in fact, they had sent him nothing even though he signed up in December.  He was not covered until March.

      My fear is that these insurance companies are going to figure out that the older folks whose policies are not "finalized", ie, unpaid, are likely to have medical needs and screw around with them until they time for signing up is gone.  It is a golden rule in the insurance world, backed by court decisions I'm pretty sure, that no payment = no insurance, regardless of why no payment was made.  

  •  I'm scheming to get off Medicaid and onto regular (1+ / 0-)
    Recommended by:
    delver rootnose

    ACA subsidized insurance.

    Medicaid asks for "ledgers" of income. So far I've been lucky in that the months when they've asked for it have been bad months. I've been working on the same job for two months and when I get paid it will look like that income for 3 months is for one. They also remove and add me to the rolls arbitrarily. Our state is administered by a private multi national, Maximus.

    And then there is the Medicaid claw back when I die. Something I for sure don't want to burden my young wife and small children with.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Wed Mar 19, 2014 at 05:58:48 AM PDT

  •  These people MUST know who is... (0+ / 0-)

    giving them a death sentence, and it's the heartless POS known as R's.

    "Really nice, but also very serious about his job." Jackie Evancho on President Obama 6/7/12

    by BarackStarObama on Wed Mar 19, 2014 at 07:06:53 PM PDT

  •  Running on ObamaCare is a mistake. (0+ / 0-)

    When you realize how low information the average Red State voter is, you will understand when so many Red State Democrat Senators are hiding.

    •  Running away from Obamacare is a mistake too (0+ / 0-)

      Red state Democrats should to run away from Obama, but they need to at least embrace some parts of Obamacare to be taken seriously.  If the only thing you do is attack Obamacare, then it just proves your opponent right.

      Medicaid expansion is one of the best ways to thread the needle because people don't associate it with Obamacare and has an immediate tangible impact.

  •  And the take away - (1+ / 0-)
    Recommended by:

    messaging, messaging, messaging.

    Now, everywhere, and often.

    The most violent element in society is ignorance.

    by Mr MadAsHell on Wed Mar 19, 2014 at 07:15:32 PM PDT

  •  Does anyone else wonder how those who could (1+ / 0-)
    Recommended by:

    benefit the most, continue to support those who would deny them their simple, human need - adequate health care?

    In addition to already being stingy with their benefits, I'll bet these states are among those with the lowest education rates, income and life expectancy as well as the highest number of churches.

    But then again, these are the sheeple who fear science and anything that smacks of critical thought.
    I guess I answered my own question, huh?

    "Takes more than guns to kill a man" Joe Hill

    by sajiocity on Wed Mar 19, 2014 at 07:20:16 PM PDT

  •  In the long term, it's just a rear-guard action. (1+ / 0-)
    Recommended by:

    Every one of those states that hasn't accepted the Medicaid expansion is just one election away from reversing themselves.

    Once a state signs up, it's signed up forever. There is no possibility of Medicaid beneficiaries being thrown off, and the hospitals having to give up the money they get, etc.

    Art is the handmaid of human good.

    by joe from Lowell on Wed Mar 19, 2014 at 07:24:28 PM PDT

  •  This was the Roberts poison pill (0+ / 0-)

    In the ACA affirmance. States pay no penalty for refusing expansion.

    •  I wish simply expanding subsidy eligibility (0+ / 0-)

      all the way down to incomes of nothing, on a sliding scale, was something the Executive Branch could do, to fix the medicaid gap, absent a functional congress.

      I know the subsidy is a really tax credit, so if you pay no tax, yadda yadda, but surely there is a way around that

      Thanks Democrats! My Obamacare is permanent coverage no one can take away - and saving $3,000 is nice too

      by sotiredofusernames on Wed Mar 19, 2014 at 07:42:48 PM PDT

      [ Parent ]

  •  I agree that the Democrats should focus (0+ / 0-)

    much of their effort on those potential Medicaid recipients if only their states would accept Medicaid expansion under the ACA, but to say that Republicans' campaigning against the ACA is "all they got" is not at all the case.

      Rand Paul is currently basking in the standing ovation he got after his stemwinder of a speech today in Berkeley  "criticizing government surveillance programs, avoiding military actions that aren't vital to national security, and rethinking the war on drugs -- drew voters from across the spectrum, including some of Berkeley's famed lefties.  Not only is Paul the Younger appealing to the Democratic base's left flank with speeches like this, he's spent the last two days carrying this message around the Bay Area to effectively raise money.  He's held at least two lucrative fundraisers.

    According to The San Jose Mercury News, Paul has found a highly receptive audience.

    In a speech peppered with references to Ray Bradbury's "Fahrenheit 451" and Pink Floyd's "Wish You Were Here," Paul told a crowd of about 400 that he will call for creation of a bipartisan committee to probe and reform the intelligence community. Much like the post-Watergate Church Committee of the 1970s, "It should watch the watchers."

    "Your rights, especially your right to privacy, are under assault," he said, noting the National Security Agency has said its surveillance programs treat lawmakers like any other Americans.

    "Digest exactly what that means. If Congress is spied upon without their permission, who exactly is in charge of the government?"

    Just as Edward Snowden broke the law by leaking information about these programs, so too did Director of National Intelligence James Clapper break the law by lying to Congress, Paul said. The nation is under watch by "an intelligence community that's drunk with power, unrepentant and unwilling to relinquish power," he said. "The sheer arrogance of this: They're only sorry that they got caught. Without the Snowden leaks, these spies would still be doing whatever they please."

    Both Robert Reich and Gavin Newsome attended the speech and had a sobering review of Paul's winning message
    "There are not too many people who can get a standing ovation at CPAC and a standing ovation at Berkeley," said Reich, now a UC-Berkeley professor.

    Lt. Gov. Gavin Newsom walked over from the UC Regents meeting to hear Paul speak.  
    "The issue of privacy is the issue of our time," Newsom said. "We're all figuring this out in real-time... and his voice is an important one in this conversation."

    It would behoove the Democrats to remind voters of Paul's stand on abortion and marriage equality to counter his current message.  But I'm not sure that will be enough to dissuade voters receptive to what he has to say about our national surveillance apparatus.  And what  can Democrats do to justify Clapper's lying to a congressional committee about domestic spying and Brenner's latest foray into spying on a senatorial investigation into CIA torture and removing from the committee's computers documents that were being used in their report?

    "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

    by SueDe on Wed Mar 19, 2014 at 07:51:55 PM PDT

  •  The only part of Obamacare that really works (2+ / 0-)
    Recommended by:
    raspberryberet, sendtheasteroid

    I am a practicing family doctor in the suburbs of San Francisco.
    I have worked for over twenty years in the same practice, always accepting MediCal (patients) among those "better" insured.
    If I had time I would begin blogging again about my day to day practice and its delights and headaches, but I am just too busy now.
    Since the advent of the ACA I have been losing money. The switch to electronic records was a big setback. I love using the electronic record and think it prompts me to provide better care, but it has cost a fortune both in terms of initial outlay, ongoing costs, and the decreased productivity (i.e. number of patients seen per hour worked) it has resulted in.
    For my patients it has been a mixed bag. Although Obamacare has made a defective product (private health insurance) more widely available, the insurance companies have done all they can to make sure that the premiums paid will accrue to their bottom line rather than to fill the health care needs of my patients. Other than those patients who have moved to MediCal, I have lost most of my patients who have moved to Obamacare. Neither Blue Cross, Blue Shield, nor Health Net seem to have included me in their new restricted panels. I was, after much inquiry, offered a contract from Blue Shield, but it offers to pay me only 95% of Medicare rates. In our community break-even is at about 105% of Medicare.... So my patients who are well enough off to get private insurance have been cut out.
    The one bright spot has been MediCal which has been enrolling many new patients and allowing them access to primary care (specialty care is still very hard to get; usually requiring me to send patients to academic centers--- for quality care but with the waits and inconvenience that such centers entail).
    Obamacare has its bright spots, but until we get truly universal single payer care the problems remain overwhelming.

    Dr. Aaron Roland is a family physician in Burlingame, CA. Follow him on Twitter @doctoraaron

    by doctoraaron on Wed Mar 19, 2014 at 10:06:44 PM PDT

    •  Sorry to hear this (0+ / 0-)

      In the current world it seems impossible that we will move to a single payer system.

      If that is out of the question (and unfortunately, I'm pretty sure it is), what can we do?

      Some providers I've talked with said there needs to be some additional work to improve the ACA.  And that is not happening because of the battle from the right to kill it outright.  If they fight this hard against a semi-free market approach, a single payer option has no hope.

      Can providers (like you) reach out to their representatives to suggest improvements?

      Sometimes reality sucks, but it's really all we have.

      by CindyV on Thu Mar 20, 2014 at 12:36:27 PM PDT

      [ Parent ]

  •  my e-mail to obama (2+ / 0-)
    Recommended by:
    raspberryberet, sendtheasteroid


    subject: embrace Obamacare

    text: If not you, who? If not now, when?

    Link I wish I added:

    "Your victory has demonstrated that no person anywhere in the world should not dare to dream of wanting to change the world for a better place." -- Mandela

    by agoldnyc on Thu Mar 20, 2014 at 05:04:34 AM PDT

  •  We have made a lot of progress in the country (1+ / 0-)
    Recommended by:

    in the last 75 years and the conservatives have been against every bit of it.

  •  Why do (0+ / 0-)

    these people keep voting for Republicans?  Why do they remain in a state that makes them the enemy?

    I love Jesus, but I drink a little.

    by Cats r Flyfishn on Thu Mar 20, 2014 at 07:24:45 PM PDT

  •  Are you stupid? (0+ / 0-)

    How can you use the picture of a black man and expect all the racist scum from crawling out of the walls?  They are afraid of black people you know, you might give some folks a stroke!

    I'm damaged and I like it, it made me what I am! BTW, my avatar is as stollen as my father's retirement fund, the old man died almost penniless. Bankers don't go to prison for breaking our laws, they buy bigger yachts.

    by Damaged262 on Thu Mar 20, 2014 at 11:10:46 PM PDT

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