So I’m a bit late with my posting. I usually post at around Midnight the night before, just so you can read this while you’re drinking your coffee at work or whatever it is you do in the mornings. However, I didn’t have all my information right, and I wanted to make sure that I had enough information to post before I go blathering on about something really really serious, and probably mostly boring. Whenever you’re combing through 200 pages of legal jargon, it tends to get a little tedious.
Anyway, I’m here to talk about really serious business. Mainly the HR3200B, which in case you didn’t know, is a bill being proposed in the House of Representatives to reform health care, and namely health insurance, as we know it. It sounds like its providing a “public option” for healthcare, which would allow people to buy a federal form of health insurance to cover themselves.
Frankly, until this weekend, I hadn’t heard anything but what the pundits have to say about it. I could not with good conscience sit here and take a side about it without reading it over myself. I’ll condense it down so you don’t have to go nuts reading it yourself, because after all, that’s probably why your reading this anyway.
OK, now why do I give a crap about this anyway? This isn’t a politics blog, right? This is about helping yourself and touchy feely stuff! Very true. However, its also about counseling, and how I help others, and how I help you. Since counseling really IS my bag, I stopped to realize that this bill could affect how I do counseling, how I run my business, and how much I get paid. Suddenly, it was clear that this bill became VERY important to me. Even though the ACA (American Counseling Association) is behind it, I figured I needed to know what it meant for me, and also for you.
Why is it important to you? Well, if you are going to get counseling using your insurance, it does make a difference if the rules are going to change about insurance. So I think its worth mentioning, and telling others, because no one else is doing it; I know, I’ve looked.
OK, time for serious business. Without further ado, here’s how I think the HR3200B will affect counseling as it stands:
1. The bill allows LMHC’s to bill for Medicare: Long ago, in a galaxy far, far away, only Licensed Social Workers and Psychologists could take Medicare. This bill seems to change that to include Licensed Counselors, and Licensed Marriage and Family Therapists. Why are they doing this? Because according to the bill, you can’t provide service under the public option unless you can accept Medicare. Makes sense
2. The bill pays out at the same rate as Medicare: I guess that’s ok, I don’t know what Medicare pays (but the bill explains something like 75-80% of what is billed). I’m not sure if that involves the billed amount or the allowed amount (yes, these are two different things). If its the allowed amount, that may not be very much fun for me, but probably fine for those seeking counseling.
3. Employees can opt out of the plan offered by Employers: I might be wrong about this, but it looks like employees can opt out of the employer offered plan if they want to go with the Public Option. You’ve got 30 days, but that’s it. Then the employer is required to enroll their employees into a health insurance plan.
Ok, let’s stop here and take a look at just this stuff. Sounds OK so far, but I have a few concerns.
1. If the federal system is like the state system, then we may be in for some trouble. I have many reasons why I don’t accept Masshealth, the state run health insurance in Massachusetts. Here are some of the reasons why:
– The require that children and adolescents take a test that asks them about their sexual history, and all kinds of other prying questions. They probably have a reason for this, but I think its in poor taste. Understandable in some circumstances, but it could be a turn off for some parents.
– They audit charts every quarter or every half year. If they don’t like the way I write my progress notes, or conduct my charts, they take money back. Not to mention the invasion of privacy.
– They take about 3 months to pay, and take every day of it to do so.
– Did I mention that they don’t pay very well.
OK, don’t get me started, but those are the main reasons why I don’t take it. I hope to heck that Medicare isn’t this way, because as a small business, I wouldn’t be able to keep the ball rolling.
2. How will this affect my business, and businesses on the whole? Honestly, I don’t think anyone has the answers to this question. A lot of people are thinking that the Public Option will reign supreme and that it will ruin the insurance industry. However, Masshealth has been in Massachusetts as long as I can remember, and the other companies are still competing. I think it will depend on how the Public Option goes, the ability to choose providers and whether or not providers get on board with it or not. My main concern is with the cost of the public option going down, the private costs will go down to compete, and the rate that providers (like me,…Hi) get paid will go down. Which determines whether or not I can keep helping people.
How does this apply to you:
1. The world is not going to end. Whether you think this is a good idea or not, the world will go on much as it always has. No one knows for certain what this will do to other insurance companies, but there will always be something they can offer that the Public Option does not.
2. Read the Bill and figure it out for yourself. Listen to other people and what they say if you want (like me, duh), but its always best to educate yourself. Yeah, yeah, I know that involves reading, but no one is going to sit there and tell you what it says without having their own agenda in mind. I mean, I have my own agenda too, but its in my effort to save my own butt.
To bring it all home, I started researching this because I felt fear about my ability to provide for my family. I was concerned about how this would affect my life and my overall livelihood. Then I realized as much as this bill could change the way I do business, there really isn’t much I can do about it. Sure, I could learn more about it, and I could teach you guys about it, but that’s about it. If it goes through, and things change, then I must change with it.
The point is flexibility with things that you can’t change. I can’t change what happens, but I can change what I do about what happens. Its got the WATER Method written all over it. So here’s me applying my own stuff to my own problems. I hope it helps you too!
Jim, you’ve done a lot of work to try and understand this stuff. I think your reading of the legislation seems to be pretty much in line with what I understand, though I have less knowledge regarding whether Medicaid will present the same hassles that the state program presents. I appreciate you going to the trouble of outlining how it might affect your practice, I think that might provide a good analogy for other forms of medical and psychological care (though I’m not an expert).
From what I’ve read, heard, and understood in my reading of the legislation, you may be slightly mistaken about employees ability to opt out of their employer coverage. The way I understand it, starting out, most people who have sufficient coverage through their employers will not be able to opt for a public plan. That option will only be available to people who are uninsured (assuming they don’t qualify for medicaid), underinsured, or whose employers choose to go with the public plan (in which the employer pays a fee to the government which will in turn be used like the employer portion of private insurance programs).
Thanks for the mature approach and examination of this issue.
A big THANK YOU for taking such a big chunk of reading material and trying to size it down for us.
I’m worried about how this will affect my livelihood, as well.
I’m optimistic as a self-employed consumer of individual health insurance policies goes.
I’m very curious about the quality of the federal plan we will be able to buy into. Most people I know who are Medicare subscribers are happy with the net result (even die-hard anti-big governmenters). Encouraging.
On the issue of fees paid to providers, I know of several large private plans that pay me less than Medicare pays. One plan in particular hasn’t given me a raise on my hourly contract rate for ten years. Maybe I’m doing something wrong? Too passive? Should be writing letters or threatening to drop off the provider list? I don’t know. But I’d rather be paid less knowing that more people are covered, than be paid less by private insurance companies who are taking exhorbitant profits.
Aaron,
Thanks for your help too! You pointed me in the right direction so I could learn a bit more about it, and understand who supported it and who didn’t. You’re probably right about the employer thing, and I guess I was pushing my luck thinking I could understand all the legal jargon.
Sandy,
Welcome! Glad to see someone from my profession in here weighing in as well. I hear you about the fee rates, and I’m glad to hear that Medicaid pays out decently well. I’m right there with you on some other insurances, as there are times I’ll do really well with one company, and do very mediocre with another company.
What can you do about it? You could choose not to accept the insurance, but that limits your client base. Sometimes its best to get paid something rather than nothing. Sometimes quantity can help over size of pay. Let’s hope we don’t have to jack up the size of our practice to continue to stay in business.
Thanks guys, good stuff!
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