My first experience with Expanded Medicaid....

[gimmethesimplelife]

Last Monday I made my first appointment for a doctor's visit covered by my expanded Medicaid HMO. I really was kinda sorta dreading making the appointment as I thought it would take two months or more to get in to see a doctor. Turns out I was seen three days later on Thursday. Amazing. The doctor who saw me was personable and professional and changed my BP meds to something stronger and changed my back pain meds and I already feel less pain just from that. I did get a request put through for physical therapy also and I'm happy about that, too. All this happened with a reasonable wait time and I even was able to fill my prescriptions in the downstairs pharmacy. Something that stunned me is that I faced no co-pays for all of this, either. Wow. On a scale of one to ten I rank this experience a 10. Things just went so much better than I hoped they would.

I'm glad I've had the chance to address these issues quickly here. There is a group in Arizona gathering signatures to put Medicaid expansion up to the voters and I realize that my days of seeing a doctor on this side of the border may not be long. I'd best address my healthcare needs and expect nothing in the future - good thing I know where to go in Mexico if need be and have my doctors lined up already.

But so far, so good - I just wanted to post my story of how I have been affected by ObamaCare - not all will have similar stories, I get that, but so far for me, once I was granted Medicaid, things have gone very well. Rob

PS And here's more good news. I have a friend who goes way back with me in the serving industry to 1998. She has a tumor and thank goodness for being so close to Mexico she was able to go to a doctor in Mexicali and found out it was benign. She couldn't afford surgery there though - didn't have the resources for the much less expensive costs in Mexico. Thank Goodness for Barack Obama and the ACA - Marissa is getting the tumor surgically removed here. I can't say how grateful I am for that. So there is another much more moving I believe ObamaCare success story.

[Lainey]

Rob,
that's great news. Not surprised, though, that the expanded Medicaid will continue to be a political issue here in AZ and elsewhere.
I'm wondering if the states who did expand will see an influx of patients from states who did not. It's another layer of crazy in the whole system, but we can only hope sanity prevails.

[gimmethesimplelife]

Rob,
that's great news. Not surprised, though, that the expanded Medicaid will continue to be a political issue here in AZ and elsewhere.
I'm wondering if the states who did expand will see an influx of patients from states who did not. It's another layer of crazy in the whole system, but we can only hope sanity prevails.I hope sanity prevails, too. Arizona is a funky state in the sense that it is essentially conservative and then out of nowhere it can get liberal on you when you least expect it. Witness the shocker of Jan Brewer pushing for Medicaid expansion to begin with - whoever would have thought that would happen? Witness that shocker back in 2000, the voters in AZ approving Medicaid for low income childless adults to begin with. Who would have thought that would happen? This state, in my opinion, often gets a bad rap in the media often due to it's gun culture. Arizona though in my experience, is just not one dimensional like that, and that keeps me here - you never truly know what is going to happen next here. It certainly can be politically interesting to live in Arizona if nothing else. Also, I realize that if this does go before the voters, we are talking of October or November this year. This is plenty of time for me to get an exercise program in place via physical therapy and take the responsibility to keep up with it on my own. If nothing else, I will be grateful to expanded Medicaid for that as knowing the exercises is something no one can take from me once I've got them down pat. And for folks like my friend Marissa, there will be time for them to get their major health issues addressed. Something else I am very grateful for. Rob

[Teacher Terry]

Nevada is also a republican state w/ a rep governor but we also expanded our Medicaid which is awesome. The Feds are paying for the first 3 years to encourage states to join. These changes were really needed. Glad things are working out for you.

[JaneV2.0]

"People should be chained by their needs for insurance to jobs they hate, that's what built this country. Do you think anyone wanted to be Pilgrim? No, but they stuck it out for the buckle insurance." --Stephen Colbert

[Lainey]

"People should be chained by their needs for insurance to jobs they hate, that's what built this country. Do you think anyone wanted to be Pilgrim? No, but they stuck it out for the buckle insurance." --Stephen Colbert

ha!

This was touched on in the CBO report. There may be a tiny percentage of adults who will now retire or cut back to part time now that they are able to purchase health insurance on the exchange vs. being tied to a full-time job with those benefits.

[Kevin K.]

This thread is of more than casual interest to my wife and I, as we are living the "mirror" situation of gimmethesimplelife's situation: we live full-time in Mexico - largely, like so many other expats here - as health care and insurance refugees, but would love to have the option of living back in the U.S. at some point. We, too, woud be eligible for Medicaid based on our low taxable income.

My research, from time spent in Arizona and New Mexico this past winter, is that the real-life viability of Medicaid is not only state specific but local as well. You have to live in a place that has docs and clinics who readily take new Medicaid patients and access in case of emergency to a hospital where you won't be at the bottome of the triage barrel. In New Mexico, a poor state that has long been very good at getting and distributing every government subsidy (I think of it as a "Hispanic Socialist Republic masquerading as a U.S.State" - and mean that as a compliment!) Medicaid is a no-brainer as your emerency coverage, but Arizona due to politics is the opposite. Unfortunately our preferred places to live are all in AZ, so we will wait and see.

F.Y.I. here is an article I came across on how folks in states without the Medicaid expansion may be able to at least get the lowest level of bronze plan with subsidy:

http://www.webmd.com/health-insurance/20130808/how-poor-might-qualify-for-obamacare-subsidies-in-states-that-dont-expand-medicaid?page=1

It's a ridiculous situation of course, though slightly less ridiculous with ACA than before. Maybe we'll live long enough to see the U.S. join the rest of the civilized world in single payer sanity, but meanwhile knowing the system and following the changes is going to continue to be both necessary and stressful.

[gimmethesimplelife]

It's nice to run across someone else living the situation of being a health care refugee from the United States. I have run across quite a few in my dealings with Mexican health care and I don't know that for people of a class higher than myself that ObamaCare is going to change all that much as the costs and deductibles are quite high. I wonder myself that for those left in the middle class if ObamaCare won't inspire more of these folks to leave the US under the thinking of - if this is the best we can do with healthcare, why am I staying and making myself vulnerable to such costs? Though, at the moment, at my level, ObamaCare is a blessing. I have no faith, living in Arizona, that Medicaid will remain intact and so am getting all my health issues taken care of quickly. I will also be crossing the border in May to have xrays done in Mexicali that didn't get done here and I don't care to fight it, xrays are very cheap in Mexico and I realize now that Mexico will be a player in my health care going forward to some degree.

I do agree with you about New Mexico - I have always found the state interesting once outside of Santa Fe as it is quite poor overall - yet also quite liberal and open minded and easy to like and respect.

Rob

[Spartana]

There may be a tiny percentage of adults who will now retire or cut back to part time now that they are able to purchase health insurance on the exchange vs. being tied to a full-time job with those benefits.I wonder what that actual number will be - or if there is even a way to track it? It seems everyone I know over 45 and with no kids to support are making plans to retire (or at least take a long time off work) asap - long before a more traditional age of 65 because they can get low cost (even free) health insurance now. Most, like me, are planning on taking advantage of the upturn in the Calif real estate market and sell and move somewhere cheaper. Something else they can now do if not tied to the jobs.

[Spartana]

This thread is of more than casual interest to my wife and I, as we are living the "mirror" situation of gimmethesimplelife's situation: we live full-time in Mexico - largely, like so many other expats here - as health care and insurance refugees, but would love to have the option of living back in the U.S. at some point. We, too, woud be eligible for Medicaid based on our low taxable income.

My research, from time spent in Arizona and New Mexico this past winter, is that the real-life viability of Medicaid is not only state specific but local as well. You have to live in a place that has docs and clinics who readily take new Medicaid patients and access in case of emergency to a hospital where you won't be at the bottome of the triage barrel. In New Mexico, a poor state that has long been very good at getting and distributing every government subsidy (I think of it as a "Hispanic Socialist Republic masquerading as a U.S.State" - and mean that as a compliment!) Medicaid is a no-brainer as your emerency coverage, but Arizona due to politics is the opposite. Unfortunately our preferred places to live are all in AZ, so we will wait and see.

F.Y.I. here is an article I came across on how folks in states without the Medicaid expansion may be able to at least get the lowest level of bronze plan with subsidy:

http://www.webmd.com/health-insurance/20130808/how-poor-might-qualify-for-obamacare-subsidies-in-states-that-dont-expand-medicaid?page=1

It's a ridiculous situation of course, though slightly less ridiculous with ACA than before. Maybe we'll live long enough to see the U.S. join the rest of the civilized world in single payer sanity, but meanwhile knowing the system and following the changes is going to continue to be both necessary and stressful.I read somewhere that you have to first become a resident of whatever state you are moving to - which can take over a year in some places - in order to sign up for that state's expanded Medicaid. I'm in Calif, a state with expanded Medicaid, and I think you have to reside here for 18 months before being qualified as a Calif resident. I may be wrong - or that may only be for those wishing to attending college here who are trying to get the resident rate that is MUCH cheaper - but that's what I read. So other states with expanded Medicaid may have some sort of time requirement to attain residency before allowing them to get on Medicaid in order to keep people from other non-Medicaid expanded states, or ex-pats living in other countries, from moving here just for the free health care.

[gimmethesimplelife]

I wonder what that actual number will be - or if there is even a way to track it? It seems everyone I know over 45 and with no kids to support are making plans to retire (or at least take a long time off work) asap - long before a more traditional age of 65 because they can get low cost (even free) health insurance now. Most, like me, are planning on taking advantage of the upturn in the Calif real estate market and sell and move somewhere cheaper. Something else they can now do if not tied to the jobs.I'm thinking yet more moving vans headed towards Texas lol.....Rob

[pinkytoe]

I'm thinking yet more moving vans headed towards Texas lol.....Rob
Since so many Californians moved to TX, it is no longer cheap:( and it's getting REALLY crowded around here.

[ApatheticNoMore]

It seems everyone I know over 45 and with no kids to support are making plans to retire (or at least take a long time off work) asap - long before a more traditional age of 65 because they can get low cost (even free) health insurance now. Most, like me, are planning on taking advantage of the upturn in the Calif real estate market and sell and move somewhere cheaper. Something else they can now do if not tied to the jobs.

I seldom meet anyone of my generation (late generation Xer - under 40) in person who talks about retirement. Oh I'm sure they exist on the net, just talking what I actually encounter in person. Then again we aren't the one's who benefitted from housing price appreciation (many will never buy - priced out - those who did buy could seldom afford in the area they wanted), the stock market goes up and down (definitely up at the moment but 2008 brought down 10 years of stock market appreciation - pretty much our first 10 years - wiped out though it's come back some), very few of us have pensions anymore, some struggle for decent paying jobs (that is worse with the millienials though), and everyone has always been told they're going to cut social security and medicare and so on before we can collect (which we should resist).

Yea if you stay below a certain income you can get free care - but who wants to project programs the federal government says it will stop paying the full tab for in a few years, a decade out into the future? Yes of course if your Medicare age then it may not matter, but if your not? Even scarier to me is projecting ACA subsidized premiums out into the future, because there is NO cap on costs as I understand it. Sure costs may be reasonable for now (at least if you get subsidized) ... but how you can you project that out? As for the 45 year olds who plan to take a long time out of work, well it is gutsy, but it seems a quite optimistic to assume someone will hire them if they decide to work again (gaps in the resume PLUS age discrimination).

[gimmethesimplelife]

I seldom meet anyone of my generation (late generation Xer - under 40) in person who talks about retirement. Oh I'm sure they exist on the net, just talking what I actually encounter in person. Then again we aren't the one's who benefitted from housing price appreciation (many will never buy - priced out - those who did buy could seldom afford in the area they wanted), the stock market goes up and down (definitely up at the moment but 2008 brought down 10 years of stock market appreciation - pretty much our first 10 years - wiped out though it's come back some), very few of us have pensions anymore, some struggle for decent paying jobs (that is worse with the millienials though), and everyone has always been told they're going to cut social security and medicare and so on before we can collect (which we should resist).

Yea if you stay below a certain income you can get free care - but who wants to project programs the federal government says it will stop paying the full tab for in a few years, a decade out into the future? Yes of course if your Medicare age then it may not matter, but if your not? Even scarier to me is projecting ACA subsidized premiums out into the future, because there is NO cap on costs as I understand it. Sure costs may be reasonable for now (at least if you get subsidized) ... but how you can you project that out? As for the 45 year olds who plan to take a long time out of work, well it is gutsy, but it seems a quite optimistic to assume someone will hire them if they decide to work again (gaps in the resume PLUS age discrimination).My thinking is that more and more people will be voluntarily leaving the US - especially the age group you mention and those younger. When you do the math, the reasons for staying put are not that many for many. Not pleasant but yet true. I do however think the ACA may serve to stifle this outgoing flow for awhile. If I had kids right now I'd be telling them to do whatever I could to appear the best I can on immigration forms to other countries, and I'm sure I'm not the only one who would give this advice these days, though you won't hear of this on the mainstream media. Nor is this the only country in which such advice would be passed down to the young. Interesting times we live in for sure, if nothing else. And a lot of what was once considered indisputedly true - gone with the wind. Rob

[Alan]

My thinking is that more and more people will be voluntarily leaving the US - especially the age group you mention and those younger. When you do the math, the reasons for staying put are not that many for many.
Rob, forgive me if I've missed the answer to this question in the hundreds of other posts you've made about escaping the United States and going to Mexico, but if that's such a great thing to do, why are so many Mexicans sneaking into the US? Am I missing some relevant part of the equation?

[JaneV2.0]

For a long time, there was no work in Mexico. They were coming here to work. Whereas in this country, there are plenty of employers who want to hire people they can underpay and exploit. Pretty straightforward.

[Teacher Terry]

I don't know anyone in their 40's that plan to quit work now that they have ACA insurance. Also my DIL is from Poland and had a professional job there. Here because her degree is not recognized she has a crappy job but her standard of living is still higher even though she is the only one working because my son is finishing his degree. They do not live in a cheap part of the country either. The grass is not necessarily greener on the other side:~)

[Spartana]

I think I probably hang out with those lazy beach bum types :-)! While I don't know many 40 year olds who would probably quit working to retire, I do know a lot who would reduce their work load to seasonal/occasional so that they can have large bulks of time off work to do other things. Probably the only thing that holds them back is medical insurance. However I do know tons of people in their upper 40's and early 50's who ware making their exit plans now that the ACA means they can have more affordable coverage. Most aren't wealthy people - the opposite usually in that they are frugal living sorts who have either a stash of money to live on without needing to work, or who will be able to get pensions once they are in they are 50 - 55.

[Alan]

For a long time, there was no work in Mexico. They were coming here to work. Whereas in this country, there are plenty of employers who want to hire people they can underpay and exploit. Pretty straightforward.I must be missing the straightforward part, unless Rob and all the others he envisions moving south of the border have different values/wants/needs/desires than the millions of others moving in the opposite direction. I suspect I'm still missing something.

[ApatheticNoMore]

I must be missing the straightforward part, unless Rob and all the others he envisions moving south of the border have different values/wants/needs/desires than the millions of others moving in the opposite direction.

Probably, to move to Mexico with a bunch of saved up American cash is to do ok if you want to I guess. Whereas to move to the U.S. with nothing (including no high demand skills - as that's mostly not skilled labor) is not to do very well in most cases even if you find employment (can't say I envy a job as a migrant worker for instance). It's just exchange rates, which are based on a lot of things, not all of them fair or just or any such thing (it's the empire with the still somewhat reserve currency afterall - for now).

[Kevin K.]

Rob, forgive me if I've missed the answer to this question in the hundreds of other posts you've made about escaping the United States and going to Mexico, but if that's such a great thing to do, why are so many Mexicans sneaking into the US? Am I missing some relevant part of the equation?

The flow of Mexican immigration into the U.S., both legal and illegal, has slowed greatly in recent years. Meanwhile, there are at least a million U.S. citizens living in Mexico - not a huge number, but by far the largest U.S. expat destination.

Mexicans come to the U.S. looking for work, and that has gotten much harder to find. Mexico's economy is on the upswing, ours is still pretty much in the toilet.

As for U.S. expats, it's always been a small trickle of people and I don't see that changing. Few have been to parts of Mexico outside of the tourist areas/beaches, the steady drumbeat of anti-Mexican fear mongering on Faux News and CNN has most of the country convinced it's nothing but narcos and shoot-outs down here, etc. etc.

For those with a spirit of adventure and some curiousity it is possible to live well down here, in areas like Lake Chapala or San Miguel de Allende that are popular with ex-pats, on what amounts to a social security level type of income. Food (less than half U.S. prices for year round fresh fruits and veggies) and health care are probably the biggest cost savings, with utilities not far behind. You have to really want to be in the culture though, and it is very different from the U.S.

Getting back to ACA and Medicaid, we have to remember that Obamacare is the kind of health care reform the Republicans were proposing not so long ago. It is a total capitulation to the insurance companies and for-profit health care system and doesn't contain costs to any meaningful degree. My prediction is that it will eventually implode into single payer, but very possibly not in any of our lifetimes. When annual increases in health care costs get to the point that even U.S. based multinational corporations see them as bad for business we might see some change.

Having lived in New Mexico and Arizona I can tell you that there are many like Rob who cross the border to get dental work and medical tests done. In Silver City NM where we lived for a couple of years there's a weekly senior's "crowns and margaritas" bus to Las Palomas where people cross, get dental work done, pick up their drugs at Mexican pharmacies at a fraction of U.S. prices, have a meal and head home. The fact that this is booming business, and that we see so many in our part of Mexico coming to pay out of pocket for procedures, is an eloquent commentary on just how broken the U.S. health care system actually is.

[gimmethesimplelife]

For a long time, there was no work in Mexico. They were coming here to work. Whereas in this country, there are plenty of employers who want to hire people they can underpay and exploit. Pretty straightforward.You got it! Rob

[gimmethesimplelife]

Rob, forgive me if I've missed the answer to this question in the hundreds of other posts you've made about escaping the United States and going to Mexico, but if that's such a great thing to do, why are so many Mexicans sneaking into the US? Am I missing some relevant part of the equation?Something you are very much missing Alan is that Mexico is actually an immigration magnet for young Europeans and Asians, especially Koreans. Do some poking around the Internet and you will find this to be true but you will never find the US media admitting to as much. I wonder why? Mexico, for all it's corruption, inefficiency, and cartel issues is regardless moving up in the world, and it's middle class is actually growing at a time when America's is shrinking. Methinks some respect for the land down south yonder is due as it is pulling off a miracle - an expanding middle class and also attracting some top young brains and talent - in spite of all the headwinds it faces. I think you are missing all of this, yes. Rob

[ApatheticNoMore]

My prediction is that it will eventually implode into single payer, but very possibly not in any of our lifetimes.

It may very well implode even soon, although I don't know whether it would implode into single payer. With some insurance companies threatening double digit price increases next year it could implode sooner rather than later though.


When annual increases in health care costs get to the point that even U.S. based multinational corporations see them as bad for business we might see some change.

I'm sure that many companies do see U.S. healthcare costs as bad for business, but then insurance companies, hospitals, drug companies, medical device manufacturers and medical providers see it as good for business, so you have at best competing factions. I suppose the point of being a mulitnational is that you don't have to hire U.S. workers if their healthcare gets too expensive. Of coures the employer mandate was also conveniently postponed so that may be a non-issue.

[gimmethesimplelife]

The flow of Mexican immigration into the U.S., both legal and illegal, has slowed greatly in recent years. Meanwhile, there are at least a million U.S. citizens living in Mexico - not a huge number, but by far the largest U.S. expat destination.

Mexicans come to the U.S. looking for work, and that has gotten much harder to find. Mexico's economy is on the upswing, ours is still pretty much in the toilet.

As for U.S. expats, it's always been a small trickle of people and I don't see that changing. Few have been to parts of Mexico outside of the tourist areas/beaches, the steady drumbeat of anti-Mexican fear mongering on Faux News and CNN has most of the country convinced it's nothing but narcos and shoot-outs down here, etc. etc.

For those with a spirit of adventure and some curiousity it is possible to live well down here, in areas like Lake Chapala or San Miguel de Allende that are popular with ex-pats, on what amounts to a social security level type of income. Food (less than half U.S. prices for year round fresh fruits and veggies) and health care are probably the biggest cost savings, with utilities not far behind. You have to really want to be in the culture though, and it is very different from the U.S.

Getting back to ACA and Medicaid, we have to remember that Obamacare is the kind of health care reform the Republicans were proposing not so long ago. It is a total capitulation to the insurance companies and for-profit health care system and doesn't contain costs to any meaningful degree. My prediction is that it will eventually implode into single payer, but very possibly not in any of our lifetimes. When annual increases in health care costs get to the point that even U.S. based multinational corporations see them as bad for business we might see some change.

Having lived in New Mexico and Arizona I can tell you that there are many like Rob who cross the border to get dental work and medical tests done. In Silver City NM where we lived for a couple of years there's a weekly senior's "crowns and margaritas" bus to Las Palomas where people cross, get dental work done, pick up their drugs at Mexican pharmacies at a fraction of U.S. prices, have a meal and head home. The fact that this is booming business, and that we see so many in our part of Mexico coming to pay out of pocket for procedures, is an eloquent commentary on just how broken the U.S. health care system actually is.I couldn't agree with you more about how broken our health care system is. I was under the illusion that Obamacare might lead to a better system - I still think here and there there will be some improvements BUT overall I see Mexico for health care in my future given the givens.

And you are so right about the economy in Mexico doing better - for illegals these days it's really better for them to drift over to Querataro or Guanajuato or Hermosillo or one of the other big (and safe) auto manufacturing cities and work the plants there than to come to the US - safer, saner, and the same culture.

Gotta say now that I see more of how ObamaCare is panning out, I'm still not against it - it's better than nothing - but it is not enough to stop people from doing the math and comparison shopping what's on offer in the US with what's on offer elsewhere - especially for those under 40. I'm glad I'm in Arizona and I cherish being close to the border - it's a real asset and I'm coming more and more to understand that. Rob

[gimmethesimplelife]

Rob, forgive me if I've missed the answer to this question in the hundreds of other posts you've made about escaping the United States and going to Mexico, but if that's such a great thing to do, why are so many Mexicans sneaking into the US? Am I missing some relevant part of the equation?Additionally, for those under 40 even dreaming of the chance to retire, many of them are going to be faced with stay in America and struggle until death or the chance of leaving the country and getting out of that nightmare scenario - provided the currency retains some value - which is anyone's guess at this point given the US per capita debt loads. Rob