Category Archives: Affordable Care Act

5 Questions about the American Healthcare System

Healthcare reform is a contentious issue in American politics.  While a few presidents—Lyndon Johnson, Bill Clinton, and Barack Obama—have signed laws that changed the American healthcare landscape, the system is still imperfect.  With the new Trump administration, the future of healthcare policy remains unclear.  Some of the changes (i.e. Medicare and the Affordable Care Act) may be in jeopardy.Picture-1000words(442x400)

Below are answers to some important questions about the American healthcare system.  In order to play a part in the continuing conversation about healthcare reform, it’s important to understand the current status of the American healthcare system.

Question: What makes the American healthcare system different than other healthcare systems?
Answer: The American healthcare systems offers a lot of choice for potential insurance coverage, private plans, and public plans including Medicare, Medicaid, Veterans benefits, and the Children’s Health Insurance Program.  Despite all of those choices, America is the only wealthy country without universal coverage.   Additionally, the American healthcare system has higher usage of expensive medical technologies—like MRI machines.

Question: Where does the American healthcare system rank on the list of world healthcare systems?
Answer: The World Health Organization’s 2000 report ranks the American healthcare system as 37th in the world—behind every other wealthy country.

Question: How much does the United States spend on healthcare every year?
Answer: In 2013, the United States spent approximately $9,000 per resident (or 17.1% of the gross domestic product) on healthcare costs.  France spent the second highest amount of money on healthcare, approximately $4,300 per resident and 11.6% of its GDP.  With the lowest healthcare spending levels, the United Kingdom spent 8.8% of its GDP or approximately $3,300 per resident.

Question:  Doesn’t higher spending means that Americans get better healthcare?
Answer:  Not necessarily.  The American healthcare systems provides quality care that is similar to the care provided by other wealthy countries.

Question: If the care is comparable, what are the higher costs for?
Answer:  There isn’t one answer to this question.  There are a range of contributing factors including: widespread use of expensive medical technology, the fee for service model, and higher volumes of patients.

Healthcare policy continues to be a contentious issue in American politics.  Citizens, experts, and politicians have spent decades debating what changes will reform the system.  Yet this is not simply an issue for the politicians.  Stay informed about the discussion surrounding healthcare reform.  These changes will eventually impact the lives (and futures) of many Americans.

Baribault, Maryann and Casey Cloyd. Health Care Systems: Three International Comparisons. EDGE: Ethics of Development in a Global Environment, 26 July 1999, Accessed January 22, 2017.
Comparing International Health Care Systems. PBS News Hour, 26 October 2009, Accessed January 22, 2017.
Murray, Christoper J.L., D Phil, and Julio Frank. Ranking 37th—Measuring the Performance of the U.S, Health Care System. The New England Journal of Medicine, 14 January 2010, Accessed January 22, 2017.
The U.S. Health Care System: An International Perspective. Fact Sheet 2016. DPE. Department for Professional Employees. AFL-CIO,, Accessed January 22, 2017.
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries.  The Commonwealth Fund, Accessed January 22, 2017.
World Health Organization’s Ranking of the World’s Health Systems. The Patient Factor: Your Voice in the Health Care Equation, Accessed January 22, 2017.

4 Important Provisions of the Affordable Care Act

The 2010 passage of the Affordable Care Act changed the landscape of American healthcare. On a large scale, it addressed longstanding systemic concerns while also attempting to bring down costs.  Nearly everyone has an opinion on the bill, yet few people really understand some of the significant changes that it ushered in.  Since 2010, much of the media coverage of the bill and the associated outcry has been reduced to 140 character summaries and soundbites.  Before forming an opinion, take time to learn about some of the things the bill did.

Young Adult Coverage: Before the Affordable Care Act, health insurance companies could remove enrolled children when they turned 19.  Some insurance plans allowed for enrolled children to stay on the insurance plan while they were enrolled as a full time student.  Under the Affordable Care Act, children can remain on a parent’s insurance plan until they turn 26.

Pre-existing Conditions: Prior to the Affordable Care Act, health insurers could deny (or charge more for) coverage because of a pre-existing condition.  Often this meant that people with chronic health conditions, like cancer, had significant trouble getting new health insurance coverage.  Some insurers even classified pregnancy as a pre-existing medical condition and would refuse to pay for related care.  Under the Affordable Care Act, health insurers can no longer charge more for or deny coverage for pre-existing health conditions.

Annual and Lifetime Limits: Health insurance plans used to be able to set annual and lifetime limits for coverage as long as someone was enrolled in the plan.  If a participant exceeded the limit, they would be responsible for all charges.  Under the Affordable Care Act, health insurance plans can no longer place limits on medically necessary care.  Limits on “non-essential” health benefits are still allowed.

Plain Language Benefits Information: Details about health insurance plans used to be hidden behind small fonts and legal language.  For many people, it was tough to understand and even tougher to compare plans side-by-side. The Affordable Care Act requires that health insurers provide participants with an easy-to-understand summary.  This mandatory standardization now allows people to easily compare the benefits and costs of medical plans.

Without realizing it, all Americans already know someone who has benefited from these four changes made by the Affordable Care Act.  Teenagers can now keep health insurance until age 26.  People with chronic conditions no longer fear being denied health insurance—or the associated extra costs of medically necessary treatment that isn’t covered.  Annual and lifetime limits are gone.  Insurances now explain their benefits and costs in an easily understandable format.  The Affordable Care Act has changed the American healthcare system in ways that have already benefited all Americans, regardless of political opinion.

U.S. Department of Health and Human Services. “Lifetime & Annual Limits.” December 5, 2014. (
U.S. Department of Health and Human Services. “Plain Language Benefits Information.” September 8, 2014. (
U.S. Department of Health and Human Services. “Pre-Existing Conditions.” November 18, 2014. (
U.S. Department of Health and Human Services. “Young Adult Coverage.” March 12, 2013 (

National Physician Shortage Projected

On April 5th 2016, IHS Inc. released a  2016 update to their report on behalf of the Association of American Medical Colleges about the projected supply and demand for physicians in American from 2014 – 2025.1


The updated report comes in at around 40 pages, and contains projections for many different scenarios that have an effect on demand for physicians services such as demographic changes like the aging of the baby boomer generation, or the ability of non-physician healthcare providers like ARNPs to provide services presently offered by physicians. The report also discusses the supply of physician services, which is impacted by the number of physicians retiring in the next decade and the number of physicians graduating from medical school who are expected to enter the workforce. The report is very detailed, and it is worth a read to anyone who faces the difficult task of recruiting physicians over the coming decades.

 Empty Waiting Room

The key findings of the report are:


1. Even under the “brightest” of assumptions, there will be a physician shortfall in 2025, it’s just a matter of how large that shortfall is. The report projects there will be between 61K-94K fewer physicians than needed by 2025. For comparison, the US had about 1 million physicians in 2012.2


2. There will be a shortfall in both primary care physicians and non-primary care physicians by 2025.


3. The largest impact on supply will be the retirement of currently practicing physicians. Just as the aging of the baby boomers will have a drastic effect of the age diagram of the American population over the coming decade, many physicians are members of the baby boom generation, so we will see a similar demographic trends. Today 11% of the physician workforce is age 65-75. That fraction will increase to one-third by 2025. The exact percentage that will retire as they age is unknown, but the aggregate effect will push down the total supply of physicians.


4. The aging of the American population will be the primary cause of increased demand for physician services. The population under 18 is expected to grow by 5% and the population over 65 will grow by 41% – a factor of 8X.


5. The expansion of coverage under the Affordable Care Act (ACA) will push up demand for physicians. Depending on how many states expand medicaid, the ACA could contribute to the shortfall by 10,000 to 17,000 physicians.

What does this all mean for physician jobs in Washington state?


It’s good news for physicians. The shortfall should push up wages for physicians as employers compete to hire the best talent. This is also good news for non-physician providers who may be able to perform services once restricted to physicians as states change their regulations in order to help address this shortfall. The labor market for physicians is national and many physicians practicing in Washington state attended medical school in other states. Fortunately the opening of Washington State University’s medical school in Spokane and its inaugural class in 2017 will lead to a direct increase in the supply of physicians coming out eastern Washington. Whether or not those new WSU medical graduates will remain in Washington for their residency is difficult to know.


All signs indicate that physician recruiters will have an increasingly challenging task ahead in the coming decade. While the exact magnitude of the shortfall is unknown, its impending presence is rather certain according to this report. Employers will need to continue to innovate and improve their recruiting practices to stay competitive with the hospital down the road.

Replace ObamaCare With BernieCare?


Bernie Sanders makes a strong case that healthcare should be a right.

Eliminating health insurance companies sounds good to me. The expense for our Obamacare ‘affordable healthcare’ insurance plan for my small company with older employees was very high, and that was WITH a $7,000 per year per person deductible – aka, a ‘catastrophic’ plan. Can’t live with it. Can’t live without it.

We all know people who are working for their insurance. Or looking for a job that provides insurance. Imagine the freedom to choose a cup-filling job, or simply leave a lousy employer, rather than staying based on your insurance.

So what would that mean to our hospitals and clinics? Many (most?) are already using Medicare rates as the plumb line for managing their expenses. Many private providers refuse to process insurance forms, offering discounted fees in their place. Can you imagine the impact eliminating insurance processing?! That alone could make #BernieCare a net gain for hospitals.   

As for all the laid-off employees? Let’s offer training for a career in healthcare! I hear it’s a growing field with a decreasing supply and increasing demand.   

What do you think? If Obamacare is the Galactic Empire, is BernieCare the Resistance, or the First Order?


Mental Health: The Next ‘Inconvenient Truth’


Could be a friend, relative, or another shooting. Might be hereditary, or from disease, substance abuse, head trauma, PTSD, or some other cause. Regardless of the who and the why, mental health care can no longer be pushed aside. [It reminds me of the debates around the impact of second hand smoke and dental health.]

The financial impact is huge, requiring both new facilities and staffing, so the need to legislate mental health treatment is not a surprise. The #Affordable Care Act was instrumental in legislating insurance coverage. State laws are inconsistent, but most have three forms of court-ordered treatment: (CLICK HERE for state specific info):

    1. Emergency hospitalization for evaluation (aka “psychiatric hold” or “pick-up”)
    2. Civil commitment – inpatient
    3. Civil commitment – outpatient

#Healthcare employment is already stretched thin from decreasing supply (retiring professionals) and increasing demand (aging population). Adding Mental Health positions will exacerbate the problem as employers seek #Registered Nurses, psychologists and clinicians specializing in psychiatric, mental health, behavioral health, chemical dependency, and addiction, as well as counselors, social workers, chaplains and parish nurses. Proving once again that healthcare is #1 for people seeking a long term career with growth opportunities and variety.

To learn more, check out these national professional associations (and Washington State chapters):

To see current job openings in Washington state:


ACA: 2015 Trends and 2016 Questions


ACA Trends (positive):

  1. In just two years the percent of uninsured adults fell from 18% (2013) to 11.9% (Apr, 2015 Gallup Poll)
  2. Medicare patient readmissions fell 8% between Jan, 2012 and Dec, 2013
  3. Many say these trends validate the ACA’s worth

ACA Trends (negative):

  1. 25% of U.S. employers offer only high-deducible health plans to employees, double the number from 2012 (2015 PricewaterhouseCoopers survey)
  2. It’s getting more difficult to sign up the remaining uninsured who tend to be young, without funds for insurance, and unaware they can qualify for subsidies (per HHS, 2015)
  3. Only a slight overall increase in enrollment is expected in the 2016 open enrollment (Obama administration, Oct, 2015)
  4. 2016 will see big cost increases for uninsured individuals, employers and insurers.
  5. 45 states and Washington D.C. are requesting premium increases insurers in for 2016 (federal government, Jun, 2015). Many increases exceed 20%, with some topping more than 50% (Washington Examiner).
  6. “If enrollment plateaus, we may see a growing discussion of whether the law is fulfilling expectations in covering the uninsured and whether subsidies for low-and-middle-income people are sufficient to make coverage truly affordable.” (Kaiser Family Foundation)
  7. Many say these trends validate the ACA’s failure

Presidential Election:

  1. There seems to be plenty of reasons to support or vilify the ACA in 2016.
  2. What’s the fulcrum for the election? ISIS? Immigration? Wall Street? ACA?
  3. Is the ACA so entrenched that it can never be repealed?

ACA Won’t Help or Harm Our Healthcare Employment Problems:

  1. Scarcity of healthcare professionals will continue, as will the aging population
  2. What do you envision? Telemedicine? More PAs and NPs? More ADNs and LPNs? Return to Masters level #PTs?
  3. One thing’s for sure: Healthcare is and will continue to be an excellent profession!


Job Seekers: How Much Do You Want to Make?

Job Seekers: Balancing the 3 legged stool: Where, What, and How Much?

A quality of life discussion that each person (or couple) needs to decide for themselves:

  1. Where do you want to live?
  2. What do you want to do?
  3. How much do you want to make?


How much do you want to make?

The classic answer is still the best. Take 3 sheets of paper and label them: Needs;  Wants; Desires. It’s a simple and difficult exercise at the same time. Even more so if you have a partner participating. The answers at the end are fascinating. Do it again in 4-6 months and see how they change.

  • Need: is based on fixed costs. Examples include rent, car payments, school loans, health issues and child support. These are easy to accumulate.
  • Want: is driven by quality of life issues such as: getting your  own apartment, or buying a condo.
  • Desire is driven by high quality of life issues such as: buy house in a safe area for a family with a good commute distance; retiring at 50.


  • Transportation: I need to get to work. I want a car. I desire a new car.
  • Living: I need a place to live. I want to rent. My desire is to buy a house.

In the end, the question of ‘How much’ pretty much answers itself. That is, until you get to the real question which is, ‘How much is enough?’ No patient on their death bed says, ‘If only I’d made more money.’

Finding a balance is where true happiness is found. For example, #Physicians#Nurse Practitioners and Physician Assistants all treat patients and prescribe medication. With the #Affordable Care Act Physicians are becoming employees. The ‘good old days’ of autonomy, freedom, power and money are gone. But the sacrifice of time and school debt remain. 




Healthcare Innovation Comes From Within

HealthworksCollective Innovation

Too much print about #Healthcare innovation needing to come from within. That’s old news. The hospitals advertising on our eRecruiting websites are seeking #Registered Nurses and masters level healthcare executives with experience at the bedside level (Care and Risk management, Utilization Review) and facility wide (Quality Assurance, Performance Improvement and Safety).

RNs are the backbone and, obviously, their insights are invaluable as the #ACA clamps down on readmissions as well as future quality measures. Directors and Managers with years of experience balancing competing priorities, including the financial realities, bring an equally qualified contribution. The hospitals that successfully combine their expertise can look at both sides of the coin and derive innovative solutions faster, as well as demonstrating the consensus needed for deployment.

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RNs hitting 0% unemployment!

#RN’s are, arguably, already at 0% unemployment. Good for them! Bad for the rest of us.


That nurse shortage in 2007? It’s back and it’s worse! Hospitals across the country have orders-of-magnitude more jobs being advertised on their websites than they did 2 years ago. And #Registered Nurses are in the thick of it.

Readmissions will destroy the thin margins at hospitals and RNs are the backbone on the floor. ADN’s provide short-term help while they complete their BSN. LPN’s and MA’s aren’t the answer.

We all know why: Boomers are retiring faster than RNs are graduating. And the buck stops at the state legislature. They have to increase the number of instructors (aka pay them more than they’re getting on the floor) and they’re loathe to increase spending until it’s too late.

It doesn’t look pretty to this Boomer. It looks ugly if you’re Gen X or a Millennial. Is there anything we can do besides writing letters?


More hospital systems are now offering their own insurance plans

KS97462(300x200)Hospital systems offering their own insurance plans is not a new phenomenon. The Affordable Care Act was simply the catalyst for change. The effort to gain more control over their own destiny starts with reducing unnecessary inpatient treatment and re-admittance rates. But the lines between traditional healthcare services will gradually disappear as they offer their own insurance products.

This February, CentraState Healthcare System in Freehold, NJ announced the creation of their own insurance product. In January these three hospital systems were reported as actively enrolling members in their own health insurance plans:

  • Health and Hospitals Corporation (New York City) has 22,000 members enrolled and expects 40,000 by the end of the year
  • L.A. Care in Los Angeles has enrolled about 8,000 members
  • Henry Ford Health System in Detroit signed up 4,000 members

But clear back in Dec, 2012 the Wall Street Journal reported these healthcare systems were offering their own health insurance plans: Piedmont Healthcare and WellStar Health System in Atlanta; North Shore-LIJ Health System in New York; MedStar Health, in DC and Baltimore; Ford Health System in Detroit; UPMC in Pittsburgh; Sentara Health Care in Norfolk; and Inova Health System in Falls Church.

Yet none of them compare to the member-based systems with their own providers, RN nurses, physical therapists, hospitals, clinics, and insurance products, such as: Group Health Cooperative in Washington and Idaho, with 600,000 members; and Kaiser Permanente with over 7 million members in California, and close to 2 million more in other states.

Our country’s healthcare system will continue to morph as more and more hospitals merge and evolve into full service providers, including offering their own insurance products and anything else they can think of to leverage their assets, increase cash flow and manage their own fate.

Think out of the box? There is no box.

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