What is Obama care really gona do for dialysis and Transplant canidates ?

[gotmoose]

Does anybody really know exactly whats gona happen to Dialysis patients and future Transplant canidates under Obama care? I havent been able to find any offical information requardling this.

[noahvale]

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[gothiclovemonkey]

so does that mean we are screwed, should the government will it so?

[Rerun]

They could safely cut the requirement that a dialysis patient must be seen by a Nephrologist once  a month.  What a waste of tax payer money.  The Nephrologist needs to see a patient in his/her office if "needed".  Only if the person is having "problems."  I could go months without seeing mine.

cut cut cut!

[Simon Dog]

Every zero-sum game has winners and losers.

One of the immutable requirements for a transplant is a successful finding on the wallet biopsy, and the uninsured are automatically excluded from consideration unless they have a boatload of ca$h.   Those who are already insured can expect an even more crowded waiting list as more people are added to the insurance roles and thus able to get past the financial gatekeeper at the xplant center.

So, those who are currently insured are losers, and those who will be able to get insurance as a result of O-care are the winners.   Whether this is good or bad is left an an exercise for the reader to figure out.

[smokinbeaver]

There is no winners and losers. It sucks, but they are going to look for ways to cut costs, and those who can not contribute and pay any taxes, will be considered not being candidates. This has been coming for a long time.  We all will be affected eventually.

Sharon

[WishIKnew]

Rerun - I'd add cutting the social worker's pay for visits once a month while on dialysis also.  The one I had the last three years was useless.  And dietitians, too.  No help there at all for me.  Maybe the rest of you had better luck.

[treesx4]

Rerun - I'd add cutting the social worker's pay for visits once a month while on dialysis also.  The one I had the last three years was useless.  And dietitians, too.  No help there at all for me.  Maybe the rest of you had better luck.

Same here, they do not do anything to help. And my doctor and nurse that come see me every couple of weeks, are in the clinic 10 minutes tops. They stop by and ask "Do you need anything?" and they are gone!

[Bill Peckham]

I have 60 posts looking at heathcare reform through the CKD lens here http://www.billpeckham.com/from_the_sharp_end_of_the/healthcare_reform/

The short answer is that Obamacare is a huge win for people who have CKD. One reason so many people who use dialysis or a transplant apply for and receive disability is concern about health insurance. For people using dialysis health insurance is a barrier to employment – one person using dialysis (and having their care reimbursed at premium private payer rates) can significantly increase a medium to small business’s per employee health insurance cost – many dialyzors feel pressure from employers to “go on disability”.

For people using a transplant they have to worry how they will pay for a life time of immunosuppressant use. Right now once you are 36 months out from a kidney transplant you have to find your own insurance because unless you qualify due to age or disability you will lose your access to Medicare. With Obamacare people with preexisting conditions will have the same access to health insurance that healthy people have, and for women their costs will be at parity with men.

The exception is in states that don't agree to implement the Medicaid portion of the law, in those states people who earn less than 100% of the poverty level will not have any new benefits, if they are not eligible for Medicaid today, and if they're in a state that opts out of the Medicaid expansion they'll not have Medicaid coverage after 2014. 

There is not a line item in the budget for social workers or dietitians, they are paid out of the bundle. All these support staff are competing for the limited resources the bundle provides; the providers would not doubt agree to the idea of ending their involvement in patient care but when used properly they are valuable members of what should be a team.

The IPAB, like any other legislation, can not bind future Congresses, but it could achieve savings that are more targeted than across the board cuts, hopefully it will preform better than expected.

[PatDowns]

Where each state stands on ACA's Medicaid expansion

http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap

[PatDowns]

Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
 
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
 
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.

This trend will probably accelerate if the states not participating also enact medical tort reform.

[Emerson Burick]

Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
 
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
 
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.

This trend will probably accelerate if the states not participating also enact medical tort reform.

I don't men to be "that guy," but I live in Massachusetts and we've seen nothing like that. Do you have any citations to back that up or is this just speculation?

[jeannea]

I think a lot of people worry about health care rationing in the future. Well we've had it for years. I had to deal with it for the 15 years I worked and had "regular" insurance. They have always decided what they will and won't pay for. I don't think that changes will be immediate or abrupt. Beauracracy moves slowly.

[noahvale]

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[Simon Dog]

There is no winners and losers.

Are you really say that there will not be a group of people who are better off because of Obama care, as well as a group that are not as well off?  That's what I mean by "winner and loser".

[Bill Peckham]

At this point in time, all comments/analysis can be considered speculation.  However, what is fact, twenty-something states are not going to participate in the extended Medicaid program and/or develop their own exchanges.  It will not be business as usual.

Comparing your state's program to Obamacare is like comparing apples to oranges.  I don't believe it involved 2700 pages of regulations and requirements as well as federal level interventions.

This is funny because this is not fact "twenty-something states are not going to participate in the extended Medicaid program and/or develop their own exchanges."

Here is a handy up to date map of what each state has said to date http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/1/

As the smoke and dust of the campaign settles I think most states will decide to go with what is in the interest of their citizens; choose to expand Medicaid.

Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
 
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
 
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.

This trend will probably accelerate if the states not participating also enact medical tort reform.

This is funny too. You're predicting that as patients move out of states, physicians will move in, that is counter to basic economics. In any case if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, no reason to move to a state where people are uninsured to avoid treating them.

In general the several states of the old confederacy that have said they will not expand Medicaid have terrible Medicaid/health insurance now yet I am not aware of a vast migration for health benefits. After 2014 there will still be today's residency requirements for Medicaid.

[noahvale]

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[PatDowns]

Don't be surprised if you see two mass migrations after Obamacare’s major provisions - as they stand now - go into effect in 2014.
 
First, states that adopt the expanded Medicaid entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare.
 
Second, doctors and healthcare providers will flock to states that resist big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors.

This trend will probably accelerate if the states not participating also enact medical tort reform.

This is funny too. You're predicting that as patients move out of states, physicians will move in, that is counter to basic economics. In any case if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, no reason to move to a state where people are uninsured to avoid treating them.

In general the several states of the old confederacy that have said they will not expand Medicaid have terrible Medicaid/health insurance now yet I am not aware of a vast migration for health benefits. After 2014 there will still be today's residency requirements for Medicaid.

I said low income people - not patients - would move to states with lower threshhold requirements for extended medicaid entitlements.  We already see illegal alien migration away from states with tougher immigration laws.  Why expect less in this scenario?

And, yes, physicians, especially those just starting practices with huge loans to repay, are going to consider setting up private practices in states with less governmental interventions or stay longer with teaching schools.

You do not know what the requirements are going to be for medicaid - excuse me, extended medicaid benefits - since the feds are setting the rules and regs.  One reason states don't want to participate, plus the Obama administration hasn't even been forthcoming on what these rules/regs will be!

You know, Bill, you don't need to be sarcastic with your responses.  I started my post with "don't be surprised if..."  You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here.  If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.

[Bill Peckham]

Thanks for reposting the "handy up to date" map that Patdowns posted before you.  And,  I will stand by my comment of fact that 20 states have decided at this time to either not participate in the extended Medicaid Program and/or develop their own exchanges.

From the map Patdowns posted, 8 states are not participating in the extended Medicaid program w/5 leaning that way.  Here's an up to date map from Kaiser Family Foundation showing how states are breaking towards forming their own exchanges (including source of decision).  -    http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17

16 have decided to default to the feds.  Therefore 8+16=24 - I won't even count the 5 leaning states.

As far as going w/the interests of its citizens, these states are.  They realize it (extended Medicaid) will cost them huge amounts of money long-term and do not want to tax citizens any further or commit their states to unsustainable financial obligations .  Unlike the federal govt., states can't print money.  Those are facts.

The main reasons given by most governors who do not want to set up state exchanges?  The Obama administration has been slow to release details about how exchanges should operate and complained that the law has proved too inflexible to meet the needs of individual states.  Funny, exactly opposite of what you say why they will end up participating.  Now, if the administration will make changes the states can live with, of course they will reconsider.

I don't think the nature of the exchanges are an issue, people with CKD will be better served by having access to insurance, whether through a state run exchange or an exchange run by the feds, from the perspective of the insured they're the same. If you need transplant meds for the rest of your life you will be able to maintain health insurance if the state runs your exchange or the feds run your exchange. What was funny is that you preface your comment by warning people about speculation and then you immediately speculate about how many states will choose which ever option.

The meaningful choice is whether to opt into the expansion of Medicaid because the Affordable Care Act does not have a plan B to get insurance to people who earn 100% or less of the federal poverty level (fpl) or whatever the state's Medicaid eligibility requirements are (and I would note that the states that are saying they will opt out of the Medicaid expansion are among the worst Medicaid payers and have some of the tightest eligibility requirements). The Obamacare subsidies kick in at 133% fpl, I'm hearing there may be a way to get that down to 100% fpl but in states that opt out the most needy won't have improved access to insurance. That's the thing that matters to people with CKD using dialysis or using (or wanting to use) a transplant: will they have access to health insurance? In some states it will depend, but for most Americans the answer is yes you will have access to health insurance.

Whether or not expanding Medicaid is a good idea is now going to be tested. We'll see if having millions of people without health insurance (10 million in Texas) is better than having millions of people with kinda crappy health insurance (Medicaid). For people who want to use a transplant the answer is it is better to have crappy insurance rather than no insurance. I think for the country it is also true - crappy is better than none - and I think for each state it is true. Now it could be that I'll look back on my support for this position in the same way you perhaps look back on support for unskewed polls, or it could go the other way and then there'll be no looking back and either way the Republican governors can campaign on it in 2016.

I said low income people - not patients - would move to states with lower threshhold requirements for extended medicaid entitlements.  We already see illegal alien migration away from states with tougher immigration laws.  Why expect less in this scenario?

And, yes, physicians, especially those just starting practices with huge loans to repay, are going to consider setting up private practices in states with less governmental interventions or stay longer with teaching schools.

You do not know what the requirements are going to be for medicaid - excuse me, extended medicaid benefits - since the feds are setting the rules and regs.  One reason states don't want to participate, plus the Obama administration hasn't even been forthcoming on what these rules/regs will be!

You know, Bill, you don't need to be sarcastic with your responses.  I started my post with "don't be surprised if..."  You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here.  If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.

To doctors those low income people are patients, so were talking about the same people - right now today, and it has been true my entire life, people can move to a different state and gain access to health insurance that they don't have access to in their home states. This has been true my entire life  but I haven't heard about the disenfranchised poor of Mississippi moving to California or New York, why would it suddenly happen after 2014? There will still be residency requirements for Medicaid in 2014, just as there are today. Ask someone who is using dialysis and insured by Medicaid how easy it is to move to a new state.

This idea that physicians will go Galt because of Obamacare is funny because basic economic theory, that even objectivists believe, is supply follows demand.  There will be more people with insurance, which means doctors will have a bigger customer base, in every state. And if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, they have no reason to move to another state where people are uninsured. If a doctor doesn't want to treat patients insured under expanded Medicaid then she does not have to treat them, she can choose to treat only those with private insurance. The market will adjust.

What I am describing is what is the current law. I don't think I am making a prediction beyond stating the obvious - Obamacare is a big win for people with CKD.

That said I think Simon Dog has a point that if more people have access to a transplant, there will be more people on the transplant list, and therefor the wait will be longer than it would be otherwise. That is a dynamic that will probably play out but it isn't a good reason to oppose expanding access to health insurance.

[jeannea]

I was listening to a radio program on NPR today. In some states, they said LA, eligibility for Medicaid is 15% of federal poverty level. That's appalling! You can only get Medicaid if you earn less than about $2500/year. We in America treat out poor horribly.

[Bill Peckham]

I was listening to a radio program on NPR today. In some states, they said LA, eligibility for Medicaid is 15% of federal poverty level. That's appalling! You can only get Medicaid if you earn less than about $2500/year. We in America treat out poor horribly.

If you're interested on how the income threshold varies from state to state for nondisabled adults check out Table 3 in this PDF
http://www.kff.org/medicaid/upload/7993-02.pdf
Arkansas wins the race to the bottom with current eligibility set at 17%; according to the chart Louisiana comes in at 25%.

[PatDowns]

I said low income people - not patients - would move to states with lower threshhold requirements for extended medicaid entitlements.  We already see illegal alien migration away from states with tougher immigration laws.  Why expect less in this scenario?

And, yes, physicians, especially those just starting practices with huge loans to repay, are going to consider setting up private practices in states with less governmental interventions or stay longer with teaching schools.

You do not know what the requirements are going to be for medicaid - excuse me, extended medicaid benefits - since the feds are setting the rules and regs.  One reason states don't want to participate, plus the Obama administration hasn't even been forthcoming on what these rules/regs will be!

You know, Bill, you don't need to be sarcastic with your responses.  I started my post with "don't be surprised if..."  You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here.  If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.

To doctors those low income people are patients, so were talking about the same people - right now today, and it has been true my entire life, people can move to a different state and gain access to health insurance that they don't have access to in their home states. This has been true my entire life  but I haven't heard about the disenfranchised poor of Mississippi moving to California or New York, why would it suddenly happen after 2014? There will still be residency requirements for Medicaid in 2014, just as there are today. Ask someone who is using dialysis and insured by Medicaid how easy it is to move to a new state.

This idea that physicians will go Galt because of Obamacare is funny because basic economic theory, that even objectivists believe, is supply follows demand.  There will be more people with insurance, which means doctors will have a bigger customer base, in every state. And if a doctor doesn't want to accept Medicaid rates they don't have to accept Medicaid patients, they have no reason to move to another state where people are uninsured. If a doctor doesn't want to treat patients insured under expanded Medicaid then she does not have to treat them, she can choose to treat only those with private insurance. The market will adjust.

What I am describing is what is the current law. I don't think I am making a prediction beyond stating the obvious - Obamacare is a big win for people with CKD.

That said I think Simon Dog has a point that if more people have access to a transplant, there will be more people on the transplant list, and therefor the wait will be longer than it would be otherwise. That is a dynamic that will probably play out but it isn't a good reason to oppose expanding access to health insurance.

Believe what you want.  Below are not just anecdotal stories.

http://www.aapsonline.org/index.php/site/article/the_risks_and_perils_of_obamacare/

http://www.forbes.com/sites/gracemarieturner/2012/08/21/the-real-tragedy-of-obamacare-has-yet-to-be-felt-by-the-poor/

http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?_r=0

http://www.humanevents.com/2012/11/01/beaten-by-obamacare-washington-doctor-throws-in-the-towel/


As far as your comment of Obamacare being a "big" win for ESRD patients, did you read OKarol's recent thread posted on the News Articles board about sensipar, Fosrenol and other meds being added to the bundle?  If so, please explain how that's going to "help" us?  Oh, you'll probably say this is just a "trail balloon" thrown out there.  (My take, if true, its a compromise in getting immunosuppressive meds covered for longer than 3 years.)

http://ihatedialysis.com/forum/index.php?topic=27922.0


All Obamacare is going to do is lead to more substandard esrd care.

[noahvale]

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[cariad]

My complaint against Obamacare is changing the whole system when 80%-85% of Americans were happy.

Source? I have a strong feeling you are misrepresenting what was actually found. There is no way - no way at all - that 80-85% of Americans were happy with the US health care system. I have yet to meet a single, live adult who did not decry the state of American healthcare when Obama took office. If they are happy with their coverage or their current doctor, they can keep it. Anyone who is not clear on that point by now just doesn't want to be informed.

You know, Bill, you don't need to be sarcastic with your responses.  I started my post with "don't be surprised if..."  You have no better handle on what's going to happen down the road than me or anyone else who posts an opinion on here.  If you did, then we dialysis patients would already be experiencing better medical care due to your expertise and insider influence.

You know, PatDowns, you don't need to be insulting with your responses. Bill has done as much for the CKD community (not just dialysis patients, but all of us!) as anyone I can name. When my transplant was failing and I was trying to get a handle on what the future was going to hold for me, I can credit two sites with providing me with the priceless information that I needed to navigate the system and get where I wanted to go. The first is IHD, and the second is DSEN, Bill's site. I received better medical care from what I learnt from reading Bill's articles and participating on IHD. He has an excellent handle on how the health care maze operates and to suggest that this should somehow translate into everyone with CKD receiving better medical care because of him is ludicrous. As far as I know, Bill is not paid a cent to put in all of those hours maintaining his site, talking to journalists, participating on other CKD sites and everything else he does in the advocacy world. If Bill had never got into advocacy, CKD patients would be all the poorer for it.

[noahvale]

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