Nursing Obamacare Schadenfreude

Yesterday's visiting Rose Breasted Grosbeaks appear to have tanked up on safflower seeds, and moved on towards their breeding grounds, which lie a little farther north, or up in the Appalachians. It's another bright, sunny, spring day here.

Math; it's hard! ObamaCare Overhead: $2,500 Per Newly Insured Enrollee

. . .Then there's the roughly $40 million the insurance industry spent promoting ObamaCare plans and the $27 million the non-profit Enroll America raised for its own enrollment efforts. (There was also $500 million spent in political ads over the past four years either supporting or attacking ObamaCare.)

Not to mention the unquantifiable costs of all the time that the president and other administration officials spent doing promotional work for the law.

Add it all up, and ObamaCare's startup cost is at least $6.7 billion. Even if every one of the 8 million enrollees pays their premiums all year, the cost is more than $837 per sign-up.

And if recent surveys are correct that just a third of enrollees previously lacked coverage, ObamaCare will have cost $2,500 for each newly insured person.

It is certainly true that much of these are startup expenses that won't recur in future years. And the sign-up numbers don't include the people who went to the exchanges and ended up in Medicaid plans. Plus, the administration expects overall enrollment to climb in future years.

But the ongoing costs of the exchanges will not be insignificant. Healthcare.gov is adding a 3.5% premium surcharge on every plan sold through it to pay ongoing costs of the federal exchange. And some states are worried that not enough people signed up through their exchanges to make them financially viable after the federal grant money runs out.

When you add in the subsidy costs, ObamaCare gets really expensive. According to the Congressional Budget Office, exchange subsidies this year will total $21 billion, with the average subsidy for each person who gets one topping $4,400.

Much of these subsidy costs, however, are simply offsetting the premium hikes ObamaCare itself forced into the market.

ObamaCare sending premiums rising at fastest clip in decades

A recent survey of 148 insurance brokers shows that ObamaCare is sending premiums rising at the fastest clip in decades.

"For the last, about, five years they've been doing this survey, so this was the largest percentage increase in any quarter since they've been doing (it)," said Scott Gottlieb of the American Enterprise Institute.

"But at 12 percent, 11 percent increase on average across all the states -- that puts it at the upper end of any increase we've seen for decades."
That is the national average in a survey done by Morgan Stanley. But in some states, it found rates are soaring.

"There are specific states with exorbitant increases," Gottlieb said. "Delaware had 100 percent increase, Florida had a 37 percent increase, Pennsylvania 28 percent increase, California had a 53 percent increase in their premiums."

Rates vary widely, often depending on the state and how highly regulated it was to begin with. Analysts, however, say the main reasons for the higher costs are not medical inflation, but rather the requirements of ObamaCare itself.

But, but, but, where's the $2,500 per family they promised to save us?

One little noticed trend of Obamacare is that it tries to lower costs by decreasing the amount of time doctors see patients, consequently increasing the amount of time spent by other health care workers; primarily nurses.  So much so that one nurse argues that Obamacare is killing the nurses.

Obamacare’s Killer Burden on Nurses

As a bedside RN working at an acute care hospital in Oakland, California, I care for an incredibly diverse patient population. Most of my patients have had health insurance through employer-based programs, private purchase, or Medi-Cal. Most have interacted with the health care system prior to being admitted to my hospital.

Now, I will take care of patients who are new to health care. Some haven’t had care in a long time (or ever). Some may have pre-existing conditions that enabled insurance companies to refuse them coverage. As they enter my care, their needs may be more complicated.

Last year, I cared for a patient who—like many patients covered through the ACA—hadn’t been to the doctor in years. She didn’t seek care until she was quite debilitated by Type 2 Diabetes.

My experience caring for this woman exemplifies the stress that patients who have never had health care may put on my hospital and nurse colleagues. This woman never had an IV in her arm nor had she ever stayed overnight in a hospital. Now, she was told that when she went home, she’d need to check her blood sugar with a glucometer four times a day and inject herself with insulin. I spent a lot of time with her, explaining things to ease her anxiety.

When you take medical care system that is well tuned to the number of workers, patients, and infrastructure and to suddenly force more people into the system, something will be seriously strained. So the answer should be more doctors, nurses and infrastructure, right?

In fact, executives at my hospital recently proposed reducing our inpatient nursing staff. They note that the number of patients admitted for overnight stays has decreased in the last few years. They say medical and surgical care has improved, and better primary care has kept patients healthy enough to avoid hospital admissions. The ACA permits hospitals to continue shifting patient care from the expensive inpatient setting to the cheaper—and more profitable—outpatient setting.

The problem with that diagnosis? My patients are not healthier. With the ACA, there are more patients entering hospital infrastructures that have been diminished. Patients visit the emergency room and wait longer before being admitted. When they do get admitted, rather than being sent home and told to follow up with their primary care physician, they are often much sicker and require more care.

Perverse incentives.