Monday, July 9, 2012

Obamacare Will lead to Loss of Jobs and Lower Quality Health Care

There are many articles and reports on how Obamacare is bad for America. Most of these reports focus on how it's bad for doctors and bad for patients and is a costly tax and a waste of money. What most people don't realize is that Obamacare will lead to the loss of nursing and ancillary jobs and will lower the quality of health care in America.

Facilities such as hospitals, nursing homes, and rehabilitation centers have the basic costs of running a business. There are the costs of the upkeep and maintenance of the facility. There are the costs involved in the housing of the patient, bed, food etc. There are the costs of the health care and ancillary personnel that need to be provided. The facility must take in enough money to cover their costs.

Looking at the financial world of health care, it’s important to realize that it’s more complicated than simply a service offered and then either the patient or the insurance pays for it. There is much more to it than that. Insurance companies work out deals, what is covered by the insurance and what it costs for the insured. Most of you get a taste of this when you compare programs, what is covered and how much you pay. The insurance company sets limits and defines what they will cover. Facilities who accept their insurance must abide by what is covered. This works well if you only need it for what is covered under the insurance. In addition to coverage, there are co-pays and deductibles, additional amounts the insured must pay for care.

With Obamacare, many will opt for the cheapest insurance they can get rather than pay the high fines involved with not being insured. “El Cheapo” insurance likely will have minimum coverage with high deductibles. People who need health care will find they are not saving money and most will find they are spending more between paying for the insurance and paying for services due to high deductibles.

A person who is paying for El Cheapo insurance because they cannot afford the higher fines for not having insurance, will undoubtedly not have the extra money lying around for co-pays or deductibles, may not readily seek out medical attention. Many doctors have cash discounts for those who pay themselves and this cost usually ends up being less than a person, particularly a young, healthy person, would pay annually, even for treatment of a chronic condition. These people would have better care if they would pay for the care themselves even if they needed to ask for charity in order to pay for it. This is why many would rather save their own money and pay for their medical expenses outright rather than have insurance.

Why then is it more detrimental for a facility, such as a rehab center or hospital, to accept El Cheapo insurance as mandated by Obamacare than it would be for her to have no insurance at all and how does this lead to a reduction in jobs? This is complicated, as there are many aspects of the case that come in to effect.

Insurance is not equal. Facilities can make more money from people paying out of pocket, even if it’s in installments, than they can by accepting insurance with poor, El Cheapo, coverage. We already see this with Medicaid, which is fine for certain things but has poor coverage for other things and therefore the facilities have to pick up much of the cost of caring for these patients. It will be similar with the El Cheapo insurances that many will be forced to choose. The patient is less likely to pay for that which isn’t covered by insurance because she will have no extra money because she was forced to buy El Cheapo insurance. She would have been better off having no insurance and being able to choose what care she needs.

El Cheapo insurance isn’t going to give people better care and would even limit care to what is covered by the insurance. El Cheapo insurance, because it is a business, wants to try not to pay for anything they don’t have to. This makes it difficult for the facility to get paid as El Cheapo will question everything so as not to pay. The facility will then have to eat the cost of that which is not covered and, because of contracts to accept El Cheapo insurance, cannot charge the patient for the difference as the facility has to go by what is covered by the insurance. The patient either does not receive the care, or the care is provided and the facility will eat the cost.

This would not be the case with private pay as the patient would be able to be charged for all services provided and the patient would be able to have a say in her own treatment above the bare minimum that is required. The facility and the patient would be able to work out a payment plan that is both acceptable to the patient and the facility. The patient would, in fact, frequently end up paying more with insurance because with high deductibles, the patient is not only paying for the care up to the deductible, but also for the insurance. The cheaper the insurance, the higher the deductible to cover in hospital or other facility costs. It is unlikely the patient would reach the deductible for the insurance plan to be of benefit. The patient, should she not have the money, is also free to seek out charity to pay for the cost. The patient not only would likely spend less paying for services herself than she would have on El Cheapo insurance and would also have individual choice for care.

In review: Under Obamacare, the El Cheapo will cover the bare minimum care and not provide for more and the patient cannot choose the care provided. The facility will eat any costs that El Cheapo refuses to cover. Under private pay, the patient will be provided minimum care and then will be able to choose what other care is provided and is able to arrange payments for the care without having paid for El Cheapo insurance that doesn’t cover what the patient needs and will only pay for bare minimum of care and the facility must, already, provide the minimum of care. El Cheapo will pay the facility less for the same care that a person would pay out of pocket for the same care and that the person would likely pay less out of pocket for service than she would on El Cheapo at a likely less amount of money than she spent on El Cheapo. The patient is not getting as much for their buck, as well as not being able to make their own health care choices, as they would paying themselves.

How does this lead to a reduction in staff and decrease of quality health care? Health care facilities are businesses that have expenses they must cover. If a facility does not take in enough money to cover expenses they must close. If facilities close, the result would be fewer beds available for those who need it. This would cause people to forgo necessary medical care because they are unable to secure a bed in the facility. It would also increase waiting times including Emergency rooms. Therefore, facilities do whatever it takes to reduce costs and increase income. With Obamacare, the income will be diminished because they will no longer have the self-pay patients, but rather patients with El Cheapo insurance which decreases income. Decreased income means a decrease in staff.

Let’s look at an example, a rehabilitation center in Florida. Each state has a minimum of care they must provide for their patients in a rehabilitation center. In Florida, that is currently 1.0 hours of nursing care per patient per day and Certified Nursing Assistant (CNA) 2.5 hours a day per patient. It is likely that with the implementation of Obamacare, the 2.5 and also the 1.0 hours of nursing care will need to be decreased even further.

Facilities that cannot stay in the black will close. It has happened before, in 2011, shortly after Obamacare was signed and due to the poor economy during the Obama Administration. At that time, the minimum number of CNA hours had been reduced from 2.7 to 2.5 hrs./pt./day. I predict, with the implementation of Obamacare, a 2.3 and 0.8 or less respectively to allow for facilities to remain solvent and to prevent closures of facilities. In addition, other ancillary departments, which do not have legally set minimums, will be decreased even further. Ancillary jobs will be combined to reduce costs. Positions will be combined; staff will be spread out thinly. Facilities will provide only the minimum care as required by law due to poor coverage by poor insurance such as Medicaid and El Cheapo insurance. All of this decreases the level of care in order for the facility to remain solvent and open.

Here’s the numbers. The number of CNAs per day (8 hour shifts), for 100 patients, has reduced from 33.75 (optimum 2.7 hours of care per patient, per day) to 31.25 (adequate 2.5 hours per patient, per day) and, if decreased to 2.3 hours of care per day the number of CNAs needed per day for 100 patients would decrease to 28.75. That is a decrease in 2.5 staff members per day. That’s 2.5 more people unemployed. The numbers are similar for nurses. With 100 patients, nurses must provide 1 hour of care per patient, that’s 100 hours per day. With 8 hours shifts that comes out to 12. 5 nurses a day. With a decrease to 0.8 hours/day, it reduces to 80 hours per day or 10 nurses, again a drop of 2.5 nurses per day. For 100 bed facility, that would be a total of 5 unemployed people.

The decrease in staff also equates to a decrease in the quality of care. Staff must care for more patients. No longer will staff have the leisure to sit and talk with patients, they will become automated machines trying to care for their patients without the time to provide for extras that, while not absolutely necessary, would improve care. An example is patient bathing, 3 times a week used to be the norm, soon 2 times a week will become the standard. Some staff will fatigue and burn out, unable to keep up with the increasing demands others will take shortcuts, diminishing care in order to finish what needs to be done.

The Obamacare mandate will lead to a decrease in health care jobs due to the increase in people with El Cheapo insurance with poor coverage which in turn causes facilities to cut staff to stay in the black and remain open. The decrease in staff can equate to a decrease in the quality of care for patients.

A comment was made that there is "a provision in the law that in order to avoid the penalty tax, a person must purchase a policy 'approved by the Secretary' of HHS. I can imagine the Department refusing to approve policies of the 'El Cheapo' type you describe. HHS may in fact demand that all policies sold be of the gold-plated Cadillac type, covering all sorts of things the owner would never need."

Medicaid would be/is already approved and everyone knows that Medicaid is king of the "El Cheapo" insurance. Call around and try to find a doctor, especially a specialist, or rehabilitation center that accepts it. If they do, they limit the number of patients they accept.

Also, they would have to approve "El Cheapo" because no insurance company would/could write a policy that could be affordable to those with lower/no income without bankrupting themselves. If the Sec. of HHS did demand insurance companies write those types of policies, many insurance companies would fold and that would mean more loss of jobs.