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Four Gifts the Affordable Care Act Has Given Americans by Its Fourth Birthday

On March 23, 2014, the Affordable Care Act (ACA) turned four. In its relatively short life, the ACA has already accomplished a great deal. To celebrate, here’s a list of the top four gifts that the ACA has given to the American people:

1. No More Pre-existing Condition Exclusions

Before the ACA was law, insurance companies routinely denied people health coverage due to“pre-existing conditions,” which could range from common chronic conditions such as asthma and arthritis to diseases such as cancer or mental illness. However, as of September 2010, children could no longer be denied coverage due to a pre-existing condition, and as of January 2014, adults are now enjoying that same right.

By way of example, on HelpHub, the Illinois site that provides technical assistance to enrollment specialists, we have heard many stories about people who are beginning to obtain insurance after being told for years that they are were “uninsurable.” Families USA estimates that 64.8 million non-elderly Americans—or 1 in 4 people—have been diagnosed with pre-existing conditions that could have led to denials of coverage in the past. That’s over 5.6 million people in Illinois alone who can no longer be turned down or charged more for health insurance.

Though over half of the public know about this “gift” from the ACA, according to a January 2014 Kaiser Family Foundation tracking poll, 53% of the uninsured remain unaware of this provision. We need to continue to publicize this incredible benefit of the law.

2. Financial Help to Obtain Insurance

Aside from pre-existing condition exclusions, another major barrier to accessing health insurance has been cost. Since employers have not been required to offer coverage, many low-wage workers never received an offer of coverage and were priced out of the individual insurance market.

Through the new Health Insurance Marketplaces, the ACA created three new ways to make health insurance more affordable. The first is premium tax credits, which can be taken by Marketplace consumers in advance to lower the amount of premium the individual or family must pay for their coverage. Consumers with incomes under $45,960 for a single individual and $94,200 for a family of four are eligible for these credits. The Department of Health and Human Services reports, for example, that nearly 5 in 10 uninsured single young adults eligible for the Marketplace could pay $50 or less per month after tax credits for coverage in 2014.

The second form of financial help provided by the ACA is cost-sharing reductions. These reduce the out-of-pocket costs, such as deductibles, copays, and co-insurance, that health care consumers can expect. Cost sharing reductions are available to health insurance Marketplace consumers who make between 100% and 250% of the federal poverty level who purchase a Silver plan. Why does this matter? It means lower prices for doctors’ visits, prescription drugs, and other care that people need—which is particularly important for people who utilize a high amount of services.

Recent enrollment numbers indicate that people are signing up for these subsidies, too. As of February 2014, 85% of Healthcare.gov enrollees qualified for premium tax credits, while 67% consumers chose Silver plans, indicating that they may also qualify for cost sharing reductions.

3. Medicaid Expansion

The ACA mandated a Medicaid expansion to all qualified adults below 138% of the federal poverty level (about $15,800/year for a single individual); this mandate filled a huge coverage gap in Medicaid eligibility for low-income adults. In June 2012, however, the United States Supreme Court made this expansion optional, and currently just half the states and Washington, D.C., have expanded Medicaid. Illinois is one of those states; last July, Governor Quinn signed the Medicaid Expansion (SB 26) into law, and according to reports at the recent Illinois Health Reform Implementation Council meeting enrollment into Medicaid has already exceeded expectations.

The number of Illinois residents enrolled in ACA Adult Medicaid is now at 200,000. This includes all Supplemental Nutrition Assistance Program (SNAP) auto-enrollment and enrollment in CountyCare, the early expansion of Medicaid in Cook County, the largest county in Illinois )which includes Chicago and some of its collar suburbs). Of pending applications, the state expects another 150,000 will be eligible for ACA Adult Medicaid. Overall for 2014, it is anticipated that Illinois will enroll over 400,000 adults into the new Medicaid program.

Together, the Premium Tax Credits, Cost Sharing Reductions and the ACA Medicaid Expansion provide low-income families with the gift of affordable health care.

4. Essential Health Benefits

The ACA gift that people probably know the least about is the 10 Essential Health Benefits (EHB) that must be included in Medicaid and health plans in the individual and small group markets. Under EHB, not only must plans now include a range of free preventive services and screenings, but also prescription drugs, lab tests, dental and vision care for children, and mental health and substance use disorder services, among other critical services. The Essential Health Benefits package ensures comprehensive services are included in your policy so you aren’t left paying premiums for shoddy coverage.

These gifts have already started to make a huge difference to the American people. The uninsured rate is decreasing; and stories from around the country are streaming in about people who are able to see a doctor when they hadn’t for years, families who are able to afford their premiums every month, and individuals who finally have peace of mind because they have a good health insurance policy when they need it.

We can’t wait to see what the next four years of the ACA brings.

Stephani Becker
Senior Policy Specialist
Sargent Shriver National Center on Poverty Law
This blog post courtesy of the Shriver Brief

St Patrick's Day Nursing Humor: Saint Potty's Day Celebration!

(HNN) While March 17th is a Saint Patrick's Day celebration for the Irish, the beer lovers and the color green, it is also a day of excitement for nurses everywhere. You see, March 17th is also known as Saint Potty's Day. That's not a typo folks. Saint Potty's Day is the glorious day of bladder salvation for hard working nurses all across this great world of ours. While St. Patrick's Day marks the arrival of Christianity in Ireland, St. Potty's Day provides a once a year opportunity for nurses to enjoy at least one scheduled pee break in a 12 hour shift.

According to legend, Saint Potty was a 14th century recluse with post obstructive uropathy. Many theologians believe Saint Potty had a rare form of early onset prostrate hypertrophy. Saint Potty rarely left his home for fear of urinating all over himself. Back in the 15th century, any man or woman caught peeing on themselves was forced to bear a yellow tattoo on their genitalia that said Out Of Order. As any woman who has ever read Harrision's Principles of Internal Medicine knows, an Out Of Order tattoo on the male genitals is a red flag symptom and any woman hoping for a long and prosperous relationship had best go on their merry way.

Once the bladder problems struck, Saint Potty never left his mother's home. Then came tragedy. At the age of 58, Saint Potty's mother died suddenly of old age. This left Saint Potty lonely and in search of companionship. March 17th happened to be the 420th annual Scent of a Women Festival. It was a joyous occasion that, for centuries, provided women an opportunity to find their pheromonic relationship for life. One can understand quickly why the smell of pee is not compatible with this meet and greet event. Move over Juan Pablo. Before his bladder incontinence struck him at the ripe young age of 17, Saint Potty was the Festival's favorite bachelor ten years running.

After 20 years of living in his mother's basement and one week after his mother's death, March 17th, 1469 marked the day of tragedy that forever changed Saint Potty's life and the nurses of this world over 500 years later. Saint Potty jimmy-rigged a crude version of today's Foley catheter in hopes of hiding his incontinence. He strapped a leg bag under his sheep skins and danced away the night at the Scent of a Women Festival. He had the pick of the litter that night. Every woman screamed "IT'S POTTY TIME" at the top of their lungs. That is, until his bag broke and his pee pee went splat all over the dance floor. Saint Potty was taken immediately to Big John's tattoo parlor and died the following week.

Fast forward to 1979. Nursling Janey Jo Johnson was writing one of her biweekly research papers titled What's The Longest A Nurse Has Ever Gone Without Peeing? when she came upon the legend of Saint Potty. She realized most nurses where just like him. What started on March 17th, 1979 as one small nursing college's celebration of scheduled pee breaks has turned into the largest nurse holiday in the world. Most busy hospital nurses have at some point or another gone their entire 12 hour shift without peeing. Saint Potty's Day is a world wide effort to provide all hospital nurses at least one mandatory three minute pee break during a twelve hour shift. One pee-r reviewed nursing journal titled Nursing Journal Of Low Urine Output questioned the merits of such a policy. They are now out of business.

Twenty-five years later, Janey Jo Johnson, RN, MSN, M&M and PRN, now a night nurse at a top 100 hospital according to Newsweek says she is proud about what she has accomplished. "Newsweek just named us the best hospital in the country for nurses to work at. I think that has a lot to do with our mandatory two pee breaks an hour we all enjoy. In fact, I've never had a UTI despite being treated for gonorrhea and syphilis three times over my illustrious 25 year career in the trenches. For us, every day is Saint Potty's Day."

Now, please enjoy these original crude medical ecards from The Happy Hospitalist Pinterest site that contains hundreds of one-liners for your professional enjoyment.

"Saint Potty's Day. Because a scheduled bathroom break is worth celebrating."

"I got to pee three times today. Said no nurse ever."

This site is for entertainment purposes only and contains humor that may only be understood by some healthcare professionals. Read at your own risk.

Hospital Quality Measures: Value Based Purchasing 2.0 (The Funny Version).

For years, hospital quality measures have been tracked by private and government insurance programs to try and improve the healthcare services received by their beneficiaries. The most recent example is the Value-Based Purchasing Program (VBP) initiative by The Centers For Medicare & Medicaid Services (CMS). How does CMS describe VBP?

"Under the Program, CMS will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a baseline period. The higher a hospital's performance or improvement during the performance period for a fiscal year, the higher the hospital's value-based incentive payment for the fiscal year would be."

This complex program has many different elements that require hospitals and doctors to excel against their peers or face penalties and payment cuts. What are some hospital quality measures being tracked under VBP? There are Process of Care measures and HCAHPS patient satisfaction surveys. There are 30-Day Outcome Mortality measures and Patient Safety Indicators. There are the tracking of Healthcare Associated Infections (HAI) and hospital readmissions. There's even efficiency measures that track spending per beneficiary.

Other programs track 30 day this and 90 day that. There are DRGs, MS-DRGs, comorbid conditions (CC) and major complicating or comorbid conditions (MCC). There is PQRS for physicians and ICD-10 and CPT and E/M and Oh, Lordy, when does this madness end?

You'd think by now we would have enough hospital quality measures to track everything, right? Think again. The Happy Hospitalist has learned VBP Version 2.0 will include the following A-Z list of new and clinically relevant quality measures that will help computer algorithms take data mining to the next level in an effort to risk stratify hospitals, patients and doctors. This newest Medicare effort is like VBP on steroids. In line with all previous Medicare efforts to reduce costs by simply stopping payment to doctors and hospitals, success with VBP 2.0 will be difficult. Happy Hospitalist sources deep inside CMS have confirmed failure by hospitals to score in the top 0.01% of every single hospital quality measure listed below will result in an automatic assumption of crappy care and a return of 99% of all payments made for the prior fiscal year. Medicare says VBP Version 2.0 succeeds in their unstated but obvious goal of simply not paying for care anymore.

Frank, a retired physician turned top CMS data entry technician, who became a master typist when physician order entry went live at his hospital last year, says his hommies in control of the CMS checkbook hope to have Medicare costs down to about $50 a year by 2017. "Because, frankly, we don't even have fifty bucks to pay you guys anymore", he said.

So here you are folks. I present to you the newest collection of hospital quality measures being tracked by CMS in an effort to eliminate hospital and doctor payments for good. If you don't yet have software programs in place to track all this data, you can purchase it for a ton of money from the AMA. They are currently providing a 3% multiple policy discount when purchased in combination with disability insurance, life insurance, Pass Your ABIM Test insurance and You Picked The Wrong CPT® Code And Now You're Screwed insurance.

CMS is interested in your opinion and will have 14 public periods of comment to hash out the details. If you'd like to leave any of your own suggestions for new hospital quality measures under VBP 2.0, leave a comment here or on The Happy Hospitalist Facebook Page and CMS will give your opinion thoughtful consideration.

A

Acting Like An Asshole-to-Anesthesiologist Consult time
Alcohol-to-Afib time
Alzheimer's Agitation-to-Angry Family time
AMA-to-Angry Letter time
Ambulance-to-Ambulate time
Anxiety-to-Ativan time
Attitude-to-Ativan time

B

Bad Breath-to-Brushing time
Bad-Heart-to-Bacon time
Barefoot-to-Banana Bag ratio
Bedridden-so-Bring to the ER time
Belligerent-to-B52 time
Beta Blocker-to-Bradycardia time
Bilateral Cellulitis-to-Been There For Years ratio
Biting-to-Benzo time
Blood Loss-to-BS ratio (a Surgical Care Improvement Project (SCIP))
Bowel Movements-Bounce Back Ratio

C

Call Light-to-Crackers time
Call Light-to-Code Blue time
Chatty-to-Charting ratio
Clean Catch-to-Clean Catch ratio
Cold Sore-to-Consult Hospitalist time
Colon Cancer-to-Colostomy time
Combative-to-Clonazepam time
Common Sense-to-Complete BS time
Complaint-to-Call the Hospitalist time
Constipation-to-Colace time
Crappy Day-to-Call Light Fatigue ratio
Crazy-to-Clonazepam time
Critical Care-to-Coroner time
Cyanosis to-CPAP time

D

Debilitated-to-Depends time
Delirium-to-Discharge time
Dementia-to-DNR time
Demerol-to-Discharge time
Dialysis-to-Denny's Discharge time
Diarrhea-to-Distressed Nurse time
Dilaudid-to-Dessert time
Dilaudid-to-Doughnut time
Distress-to-Dilaudid time
Distress-to-Doughnut time
DNR-to-Don't Be Agressive But CPR Is OK ratio
DJD-to-Disability Request time
Door-to-Dilaudid time
Drug-to-Doughnut time
Drug Rash-to-Dermatology Consult time
Drunk-to-Discharge time

E

Ear Ache-to-ER time
Emaciated Elderly In the ER rate
ER-to-Empathy ratio
Ethanol-to-Entertainment time
Extubation-to-Exiting ICU time

F

Faking It-to-Full Workup ratio
Fall-to-Freakout time
Fentanyl-to-French Fries time
Fever-to-Full Workup ratio
Fibromyalgia-to-FMLA Request time
Fibromyalgia-to-Funny Allergies ratio
Frailty-to-Foley time
Frequent Flyer-to-Full Of It ratio
Full Code-to-Frailty ratio

G

Gangrene-to-Guillotine time
Gastric Bypass-to-Gimme Seconds time
Giving It Up-to-Gonorrhea time
Going Off Call-to-Go To The ER ratio
GOMER-to-Getting a Ride Home time

H

Haldol-to-Happy Nurse ratio
Haldol-to-Hope This Works time
Hot Meal In the ER-to-Hotel Discharge Time
Head Trauma-to-Haldol time
Healthy-to-Hospital Acquired Half Dead time
Hip Fracture-to-Heaven time
Histrionic-to-Haldol time
Homeless-to-Hypothermia ratio
Half Dead-to-Hotel Discharge rate
Hospitalist Consult-to-Hospice time
Hyperglycemia-to-Humalog time
Hyperventilation-to-Haldol time

I

Impatience-to-iPhone ratio
Intoxication-to-Intubation time
Irritation-to-ICU Transfer time
Irritation-to-Intubation time
IV-to-Infiltration time

J

Jailed-to-Jacked-Up-In-The-ER time
Jelly Doughnut At Nurses Station-to-Joint Commission Arrival time
Jim Beam-to-Jaundice time
Joblessness-to-Just Fill Out My Disability Papers time
Joint Pain-to-Job Note Request time
Junkie-to-Jugular Line ratio

K

Ketosis-to-Kayexalate time
Kegger-to-Ketosis time
Kleenex-to-Klonipin time
Knucklehead-to-Knife Injury ratio

L

Lactulose-to-Look Out Below time
Leg Edema-to-Lasix time
Leaving AMA before Lunch percentage
Leopard Tights Leaving AMA percentage
Lethargic-to-Lipstick time
Loculated-to-Levaquin time
Lipping Off-to-Lorazepam time
LOL Leaving AMA-to-LMAO ratio
Lung Cancer Diagnosis-to-Lighting Up time

M

Medicaid-to-Manicure ratio
Melena-to-Misty Autumn Sunrise Spray time
Melena-to-Morgue time
Migraine-to-MRI time
Migraine-to-Morphine time
Morphine-to-Manwich time

N

Narcotics-to-Narcan time
Narcotics-to-Nausea time
Narcotics-to-Needs Admitting time
Nasty-to-Nystatin time
Nausea-to-Nasogastric Tube time
Norco-to-Naked time
Nothing Is Still Wrong-to-No Need To Go To The ER Again time

O

Out Of Control-to-Olanzapine time
Overdose-to-OMG Really? time

P

Pain In My Ass-to-PCA time
PEG Tube-to-Palliative Care time
Pen Pal-to-Four Point Restraint time
Percocet-to-Perfect Press Ganeys ratio
Percocet-to-Pork Sandwich time
Phenergan-to-Feel Good time
Psychosis-to-Sitter time
Polypharmacy-to-Palliative Care time

Q

Questionable-to-Quality ratio

R

Respiratory Rate-to-Record 20 ratio
Rest Home-to-Resuscitate ratio
Restlessness-to-Restraints time

S

Sedation-to-Shaving It Off time
Seizure-to-Spazzing Out ratio
Sterile-to-Staph aureus time
Sedation-to-Somnolence ratio
Sometin' Really Bad-to-Steroids time
Sometin' Really Bad-to-Surgery Consult time
Spit-to-Sputum Sample ratio
Stick Around For 3 Midnights-to-SNF ratio
Stupid-to-Sedation time

T

10/10 Pain-to-Tylenol ratio
Tachycardia-to-Telemetry time
Too Obese For Ortho Consult rate
Too Old For Ortho Consult rate
Tourniquet-to-Transfusion ratio
Train Wreck-to-Transfer time
Trash Talking About Transfers To Other Floors ratio
Trauma-to-Transfer time
Trauma Drama-to-Totally Unnecessary Admission ratio

U

UTI-to-Urology Consult ratio
Urine Output-to-U Don't Have To Worry About It ratio
Urosepsis-to-You've Got To Be Kidding Me ratio

V

Vague Complaints-to-Van time
Vanishing Vein-to-Victory time
Venereal-to-Valcyclovir time
Very Sick-to-Vital Signs time
Very Sick-to-Ventilator time
Veteran-to-Viagra ratio
Vindictive-to-Ventilator time
Violent-to-Versed time
Virgin-to-Venereal Disease ratio
Vocal-to-Ventilator time
Vomiting-to-Vital Signs time
Vulgar-to-Versed time

W

Waiting at the Nurses Station For Discharge-to-WTF time
Walking the Halls-to-Won't Go Home ratio
Weakness-to-Wonder If We'll Find Something This Time ratio
Weakness-to-Worthless Workup ratio
Weekend-to-Waiting time
Worthless Workup-to-Work Note Request time

X

X ray-to-Expect Result time

Y

Yeast-to-You Need a Nursing Home ratio
Your Baby Daddy Sent You-to-You're Not Getting A Pregnancy Test On My Time time
Young-to-You're Making Me Yawn time
You're Irritating Me-to-Yankhauer time

Z

Zonked-to-Xanax ratio

"My ER has the highest Percocet-to-Perfect Press Ganeys in the country. Just so you know."

"We have the fastest Dialysis-to-Denny's Discharge time in the country. Just so you know."

We have the fastest dialysis to Denny's discharge time in the country nurse ecard humor photo.

"My floor has the best anxiety to Ativan time in the country. Just so you know."

"At my hospital we have the best irritation to intubation time in the country. Just so you know."

"At my ER, we have the fastest Percocet-to-Pork Sandwich time in the country. Hurray!"

You can find hundreds of other original medical e-cards on Pinterest from The Happy Hospitalist too.

This post is for entertainment purposes only. It contains humor that may only be understood by some healthcare professionals. Read at your own risk. If you believe any of this is real, we have a hospital quality measure that's just right for you. It's called Geodon-to-God Made You Special Too ratio.

The Obamacare Lady: What made me want this job?

Last year, I accepted a position to be an In-Person Counselor with the State of Illinois. You may also have heard the terms Navigator or Assister used to describe this job. I help people with the Affordable Care Act. A few people have called me, “The Obamacare Lady.” Yes, I help people understand “Obamacare” and help them determine what help they may qualify for in obtaining health insurance.

What made me want this job you ask? Well, I was drawn to this job for a number of reasons:

First, I like helping people. Prior to starting the training for this job, the only thing I knew about the Affordable Care Act was that it would help people like my Mother get cheaper healthcare. My Mom had a heart attack a few years ago and since then, her health insurance premiums went through the roof. And by roof, I mean they were more than a mortgage payment on a 3 bedroom house!! Yikes! That seemed crazy to me. So, I wanted to do this job to help people like my Mother and clients like Kathy. Kathy* is a small business owner and has a pre-existing condition. Her business has been quite profitable in the past, but since 2008, things have been rough. Due to the high costs of health insurance, especially with her pre-existing condition, she could not afford to pay her rent and eat if she purchased a health plan. So, she hasn’t had health insurance for years. She has been going without her medication and has just been hoping that her condition has not progressed. We met and completed an application together and found out that she is eligible for a tax credit and reduced out of pocket expenses. She is thrilled to be able to purchase a health insurance plan for $ 150 a month. These stories are my every day.

Second, I’m all about saving money. I love to shop for the best price for everything. I wait for sales, clip coupons and save my money for a rainy day. I get a little thrill out of helping someone save hundreds of dollars on their health insurance. It’s fun for me.

Third, I like to know the facts. This has been quite the topic of conversation. Almost everyone has an opinion. Over the years, it seems our news sources now always have a particular slant one direction or another. It is pretty difficult to find someone that will give you both sides to a problem or issue. So, my solution was to get boots on the ground and learn about the ACA myself and make my own decisions.

This job is not for the faint of heart. The reason that I have kept this job is that I am persistent and resilient. On a typical day, I get to see a formerly stressed, worried and confused individual walk out of my office with a little less weight on their shoulders, a little more money in their pocket and much more confident about their future. But getting there isn’t always easy. The rules to the Affordable Care Act are complex and each person’s situation is different, but that has been the fun part of being “The Obamacare Lady.” I meet so many interesting people and have a bird’s eye view of the diversity in our state. Illinoisans are beautiful, generous and hard-working.

Back in October, when the website wasn’t working very well, every person asked me if people were treating me okay. They were concerned that someone would take their anger and frustration out on me. Not a single person did. Then, people were concerned about all “those people” that might be taking advantage and defrauding the system. They wanted to make sure there were ways in place to catch the “cheaters.” After a while, all these questions made me laugh. No. Everyone I meet with is just like you. We want the same things. We want to provide things like health insurance for ourselves and our family. We are willing to sacrifice and work hard to do it. We want to obey the law. We want to be honest and tell our truth. We want to pay our own way and don’t want anything for free. Our politics and opinions on this Affordable Care Act are varied to be sure, but the similarities among us are so close. We are too hung up on headlines and sensationalism to see it.

By Barb Silnes

In-Person Counselor

HEALTH FOR ALL

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