notshipman

What made you presume that Bob? Have been working here for the past 2 months as Faculty at a University Hospital.

So yes I am experiencing it first hand! Just last week our department chair said that ACA had reduced hospital income by 17% and projections are even worse for next year.

Just because I disagree with you and Giantaxe just like the majority of US physicians over ACA doesnt mean it should irk you so much. It is a divisive subject as I'm sure you've seen.

Even though I now work 70 hr weeks with less holiday than the UK still would never return to work in the UK system. I can get an MRI here within the hour, in the UK I waited 6 weeks etc etc

notshipman

See above post. Am criticizing from within the system even though am not in private practice I admit. Our hospital has had to reduce its charity care budget by a 25% due to ACA. Nobody gets turned away still which is a good thing.

scrubbedexpat099

That would make sense, less people need charity care.

hungryhorace

Personally, i'd prefer to work less hours in the UK and use private healthcare (either purchased privately or via my employer) to get that MRI scan. Surely?

notshipman

Far from it as a lot of those people cant afford the ACA plans - 'sticker shock as you mention'

notshipman

Sorry Horace I was meaning when I order tests for my patients in the US vs the UK nothing to do with personal requirements

robin1234

So .... Those people had affordable plans prior to ACA?

notshipman

Nope they didnt but we had more funds to treat them which have now been reduced due to ACA

robin1234

Surely it's better to have health insurance than hope you'll luck out and be treated as a charity case?

scrubbedexpat099

It is based on income here. Maybe he is in a State that has not expanded Medicaid?

durham_lad

Isn't that situation just crazy? I see a lot of threads on early retirement forums where people are wrestling with this issue. Early retirees (not yet 65 and eligible for Medicare) typically have a lot of control over their taxable income since many have small or no pensions so are withdrawing sums from their retirement savings accounts to live on.

If you withdraw $1 too much over the maximum allowable ACA income you lose 100% of the ACA subsidy costing thousands of $.

At the low end if you don't have enough income you don't qualify for the ACA at all and have to rely on the State-run Medicaid, but if the State you live in hasn't expanded Medicaid then you can't get health care from either system.

Giantaxe

ACA subsidies taper as one's income increases from the Medicaid level to 4x the federal poverty level. Perhaps they don't taper enough? But I know when I played with the CA caculator, I didn't see anything as drastic as a thousands of $ difference at the cut off point.

The Medicaid thing is a disgrace. Many states are refusing it merely for political reasons, screwing their own residents in the process whilst their federal tax dollars effectively get moved to states that embraced the expansion. A study in Louisiana, for example, showed the state would be economically better off expanding Medicaid, but its governor likely will run for the Republicans in '16 and he can't be seen as doing anything positive with the ACA if he wants to get past the primaries.

Giantaxe

I stand partially corrected. I stand behind my statement that you didn't see the consequences of the pre-ACA system.

I would expect and hope that charity care would decrease, as I would hope that care that ended up being uncollectable would. If you are in a state that embraced the Medicaid expansion, then your hospital should be seeing a big reduction in uninsured patients. Or are you in a Medicaid refusenik state? If so, blame your state government not the ACA.

durham_lad

The cliff at the top end is real and TIME Magazine did an article on it this week with some concrete examples. I think a family of four with an ACA silver plan lost thousands of $'s in subsidies if they earned $1 over the upper limit.

The TIME article requires a subscription but here is a similar article

http://www.valuepenguin.com/2013/07/...s#.U49J9igzR2A

Giantaxe

How are you defining "can't afford". What's a reasonable percentage of ones income to spend in healthcare?