Obamacare Costs Result in Sticker Shock for Some Americans

As a result of the advent of Obamacare, many Americans were filled with high hopes that they would encounter more affordable health insurance rates. However, for some, optimism quickly diminished after discovering the healthcare coverage options under Obamacare..

A small business owner in California recently found out that she earned a bit too much to be considered for federal subsidies, which would help with her purchase to participate in Covered California, the state’s new healthcare exchange. Furthermore, her current rates have shot up almost 10 percent, due to the fact that policies are required to undergo an upgrade in accordance with the new law.

This small business owner is among many other Americans who currently purchase coverage on their own terms, but will now be forced to find new coverage as a result of their current policies being rendered outdated by the health law. Consequently, millions of Americans are finding that the new plans offered through the Affordable Care Act are not exactly affordable.

Covered California was created to aid more than 5 million Californians who were uninsured or purchased healthcare on their own terms. However, although federal tax credits are readily available to help reduce coverage costs incurred in the new healthcare marketplace, more than half of the consumers served by the initiative won’t even qualify for coverage.

Lastly, individuals enrolled under Covered California may see an increase in the cost of premiums. This would be due to two influential factors: a prohibition enacted on denying coverage to people with pre-existing medical conditions beginning Jan. 1, and the new requirement for policies sold next year to cover a minimum number of benefits.

ACA: Healthcare Coverage in the Online Marketplace

Now that federal and state online healthcare exchanges are live, questions are swirling about the available coverage for eligible consumers. How much will it cost? What will it cover? What if I don’t sign up?

The marketplaces will vary from state to state, even those run by the federal government at healthcare.gov. Variations include plan availability and pricing, Medicaid eligibility, and how the exchange itself is run.

However, there are consistent policies that will apply to consumers in all fifty states and the District of Columbia:

  • All plans will cover, at a minimum, ten benefits defined by the ACA as “essential.”
  • Five levels of coverage will be available with sliding price scales, from Catastrophic (only the most basic disaster coverage) to Platinum (plan pays 90 percent of costs)
  • No plan’s availability or price can be affected by pre-existing conditions
  • If you are not otherwise exempt, you will face an increasing annual fine for not having insurance…
  • BUT you may be eligible for tax credits or rebates to lower premiums and out-of-pocket costs, in some states by as much as half

Young people will absorb higher premiums than are currently available in every state on the federal exchange, though this goes hand-in-hand with the more comprehensive plans that will replace currently available coverage. In addition, older and sicker consumers who purchase coverage through the marketplace will benefit from lower premiums that are unaffected by pre-existing conditions or a dodgy medical history, as noted above. In all, healthcare pricing will depend on where you live, your age, and current tobacco use.

Tax subsidies for purchasing insurance are dependent on household income and the availability and cost of qualifying employer-provided insurance.

PRN Funding can help small to mid-sized healthcare vendors who do not qualify for tax subsidies to purchase insurance through their state’s marketplace. Healthcare factoring gives vendors immediate access to cash through the sale of their receivables, which they can then use to cover premiums and other expenses. Read more about PRN Funding’s factoring services.

Nurse Staffing Levels Make the Difference in Patient Care

Nurse and author Theresa Brown illustrates a critical element of hospital care in The New York Times: the availability or lack of proper nurse staffing. A properly-staffed hospital floor – one with a manageable nurse to patient ratio – allows nurses to fulfill their more mundane responsibilities without sacrificing their role as first responders to patient issues. An improperly-staffed floor, however, will see larger numbers of patient injury and infection. For patients, adequate nurse staffing can make the difference between life and death.

A House bill introduced in April cites research that directly links nurse staffing levels to patient outcomes, in terms of patient satisfaction as well as patient mortality and cost to healthcare providers. Despite nurses comprising a hospital’s largest labor cost subset, hospitals can more than offset the cost by avoiding a number of far more costly “adverse patient events” that may result from low staff levels.

While there is concern that hospitals will balk against potential regulation of this kind, hospital executives by and large are more worried about the quality of patient care than about the cost. Hiring temporary nurses is as costly as employing permanent staff, but it may provide the opportunity to avoid many of the hidden costs associated with permanent employees – especially an estimated 12-13 percent of costs associated with non-productive time.

The need for capable, talented nurses will only continue to rise, and temporary nurse staffing agencies are well poised to expand their business by filling open positions. PRN Funding has the tools to help your staffing agency grow while maintaining a steady cash flow.

Find out more about PRN Funding’s nurse staffing factoring programs.

Quitting Caffeine: Kicking the Habit Isn’t That Simple

While caffeine may seem like a harmless but necessary drug to get you through the day, the Wall Street Journal reports that it’s now the basis of two official diagnoses in the mental-health bible released in May, with a third under consideration. The most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, frequently called DSM-5, includes both caffeine intoxication and withdrawal. Both of these conditions are counted as mental disorders when they harm an individual’s ability to function in daily life.

Caffeine intoxication had been included in the previous version of the manual, known as DSM-IV, as a diagnosis. However, caffeine withdrawal was upgraded in DSM-5 from a “research diagnosis” to a diagnosis. Also, caffeine use disorder, which is when a person suffers disconcerting side effects and isn’t able to quit, was added to DSM-5 as a research diagnosis, meaning it needs more analysis to be included.

However, the new mental health diagnoses come with debate.

“Caffeine intoxication and withdrawal both occur fairly frequently but only rarely cause enough clinically significant impairment to be considered a mental disorder,” said Allen Frances, who chaired the task force that established the previous version of the DSM and has been an outspoken critic of the latest version. “We shouldn’t medicalize every aspect of life and turn everyone into a patient,” he added.

“The symptoms [of caffeine withdrawal] overlap with a lot of other disorders and medical problems,” said American University psychology professor Laura Juliano, who guided the DSM-5 Substance-Related Disorders Work Group. “We’ve heard many times people went to the doctor for chronic headaches or because they thought that they had the flu and it turns out it was caffeine withdrawal and they didn’t even know it.”

While caffeine is addictive, studies have shown that it is actually related to some health benefits. Nevertheless, various experts say that some individuals should avoid caffeinated goods, like those with anxiety, high blood pressure, insomnia, and diabetes.

In order to be diagnosed with caffeine withdrawal, a person has to experience at last three of five symptoms within 24 hours of stopping or decreasing caffeine intake: headache, fatigue or drowsiness, depressed mood or petulance, difficulty focusing, and flulike symptoms like nausea or muscle pain. Withdrawal symptoms often begin 12 hours after consumption and reach their peak at 24 hours.

For the majority of people, the symptoms will disappear in around a week and that may be preferable to spending a few weeks decreasing your caffeine intake only to find that the last step in quitting still leads to withdrawal symptoms.

Among routine caffeine drinkers who go without caffeine, headache is reported about 50% of the time and functional impairment about 13%, said Dr. Roland Griffiths, a professor at Johns Hopkins University School of Medicine in psychiatry and neuroscience who advised the DSM-5 work group.

New Bill Enables RNs to Determine Hospital Staffing

In a medical setting, those actually caring for patients arguably have the best understanding of how much staff is needed to do it properly. In light of this, a new bill has been introduced to Congress that would allow registered nurses to have a larger role in hospital staffing levels.

Staffing Levels Outcomes

The Registered Nursing Safe Staffing Act of 2013 (H.R. 1821) is a bipartisan bill sponsored by the co-chairs of the House Nursing Caucus. It has the backing of the American Nurses Association (ANA), who claim that higher staffing levels are directly linked to better patient care. Research shows that appropriate staff levels lead to lower rates of patient falls, infections, medical errors, injuries, and death. When negative events occur at a hospital, low staffing rates are usually a contributing factor.

What the Bill Entails

The safe staffing bill would require that hospitals establish committees to create unit-by-unit staffing plans. Their plans would take into account several inputs, including number of patients per unit, experience of the floor nurses, and technological capabilities. It would also require that hospitals that participate in Medicare would have to publically report the nurse staffing plans for each unit, provide whistleblower protection for those who complain about staffing, and place limits on the practice of “floating” nurses.


If the bill passes and nurses have more say in staffing levels, we might see high demand for more nurses to fill positions. Temporary nurses might become more needed, and therefore staffing companies will also see an uptick in demand for their services. Factors will be busy funding these institutions so that they can grow their operations. Hopefully the ultimate end result of this legislation will be better patient care at hospitals—then everybody wins.

The Home Health Care Labor Law Debate

PRN Funding’s founder and president Phil Cohen recently published an article on the Factoring Investor detailing the current debate over home health care labor law. Despite the fact that PRN works with home care companies every day, the NPR article “Home Care Aides Await Decision on New Labor Rules” that describes the controversy came as a surprise.

The Current Law

Currently, 2.5 million home health care aides in the US are not required to receive minimum wage or overtime due to an amendment in labor law from 1974.

Instead, home care givers are treated legally like “adult babysitters” even though they provide an important and valuable service and typically work 12 hours a day or more and on weekends. Almost every other employee in the US receives minimum wage and overtime pay under the Fair Labor Standards Act (FLSA)– including nursing home workers, who perform the same kinds of tasks.

Changes in the Works

According to the article, the Obama Administration announced in 2011 that the law would be revised but has yet to make a formal approval for the changes. The new rule would ensure that home health care aides are guaranteed both minimum wage and overtime as prescribed by the FLSA.

The changes to the regulations are being proposed now because while the law has stayed the same for decades, the home health care industry has grown and transformed. 80 million baby boomers are aging fast and the home health care industry has more than doubled in the last eight years.

The Controversy

Just like with any issue, certain nuances make enacting the change less straightforward than it appears. While it seems logical that home care workers be treated like the rest of us, certain groups don’t want to see the law change because of unintended consequences.

Certain home care companies and trade groups like the National Association for Home Care and Hospice support paying employees at least minimum wage, but not overtime or weekends. The reasoning is that home care profits are mostly fixed by Medicaid, and the cost of overtime couldn’t be offset by a raise in price.

Another association that is concerned about the possible change is the disability rights group ADAPT. While they want workers to be adequately compensated, they cannot support the changes because the higher price tag means that people with disabilities most likely will have to find several attendants. This is disruptive and potentially dangerous for the residents who need consistency.

Implications For Factoring Companies and Brokers

For a factoring company or broker that deals with home care or staffing companies, a change in labor law has implications for business.

If the law is revised by the Obama administration, then home care aids will have to be compensated more by their companies. To counteract this, the companies will most likely restrict the number of hours that the employees can work, and look for more part-time workers—especially with Obamacare coming into full effect in 2014. Home care companies will have to change their business somehow to deal with the change in law, and change usually requires cash flow.

Factoring companies and brokers should be prepared to handle the changes to home care and staffing, and for brokers especially this requires having within your network a company that specializes in healthcare.