Recalling the Why of Health Care Reform

By Jacob Molyneux, AJN senior editor ACA ruling imageIn a brief analysis of the gradual rollout and effects so far of the Affordable Care Act (ACA) at the start of this year (“The ACA Continues to Run the Gauntlet”), I reviewed a few of the issues the law was intended to address when it was passed in 2010:

* the highest per capita expenditures of any health care system in the world

* consistently worse outcomes on measures such as infant mortality rate than most other developed nations

* increasing numbers of uninsured Americans each year, to over 50 million in 2009, the year before passage of the ACA

* unsustainable annual increases in health insurance premiums and drugs costs, leading to astonishing rates of medical bankruptcy

* a Medicare reimbursement process that rewarded the volume of care provided rather than the effectiveness of that care

These worsening issues had become impossible to ignore. No one believes the ACA is a perfect law; there were too many cooks in the kitchen for that. But it’s at least a good faith attempt to address real problems, to get a framework on the table that can potentially be improved upon. […]

March 4th, 2015|health care policy, Nursing, Patients|0 Comments

They’re Not Taking Away Our Puppies (And God Help Them If They Do)

By Jacob Molyneux, AJN senior editor/blog editor

I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.

The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like. […]

September 30th, 2013|health care policy, Patients|9 Comments

48 Years of Medicare (and Counting)

By Shawn Kennedy, AJN editor-in-chief, and Jacob Molyneux, senior editor

Next week marks Medicare’s 48th anniversary. President Lyndon Johnson signed the legislation creating Medicare on July 30, 1965, guaranteeing health coverage for the elderly. With the gradual implementation of the Affordable Care Act (ACA; 2010), Medicare, along with other government and private forms of health insurance, is undergoing changes, with efforts being made to rein in rising costs, combat fraud, tie quality of care to reimbursement, and so on.

PPresident Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration. President Lyndon B. Johnson signing the Medicare Bill. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

With the ACA’s date for mandated purchase of health insurance fast approaching, some states are setting up state-run health insurance exchanges to provide consumers with a standardized menu of health insurance plans in order to make it easier to purchase a plan that fits both budget and health care needs. Other states have refused to participate (see “Policy and Politics: Update on the Affordable Care Act” in the April 2013 issue of AJN); […]

July 26th, 2013|health care policy|0 Comments

Health Care Reform Works—If You Work It

Medical Bills

By Gail M. Pfeifer, MA, RN, AJN news director

My husband and I both recently had preventive screening colonoscopies, which are now covered under the Affordable Care Act (ACA) as preventive care for adults over 50. That coverage, if you purchased a new health insurance plan on or after September 23, 2010, which we did, means you do not have to pay a copayment or coinsurance or meet a deductible if you use an in-network provider (here’s a full list of preventive services covered under the new law). You would think that medical office billers and insurance companies would know that by now.

Although some plans have clauses that let them off the hook on this rule, ours does not—these tests should have been covered. Lucky for us, we knew it when the bills came in. To make a long story short, I was billed for the “surgery” and for the anesthesia. So I first called the billing department of the GI specialist’s office and asked them to rebill the procedure correctly, as preventive screening. No further bills from them, for me, but shortly afterward, my husband was billed by the same office for “surgery” occurring months later—same doc, same procedure, same billing office. He’s following up with phone calls as I write.

I next called the anesthesia billing office, which said our insurance company […]