ACA Credits Come to an End

Episode Transcript

Speaker 1 (00:00):
Thirteen ten WIBA and full scope with Wisconsin's direct care doctor,
doctor Nicole Hempkiss. Doctor Hemkiss of course comes to us
from Advocate MD. It's a primary care practice with four
clinics west side of Madison, right in Middleton on Glacier
Ridge Road. East side of Madison, Fair Oaks av Janesville
at ten twenty one Mineral Point Avenue, South South Madison,

(00:23):
Fitchburg area, right on Signing Road at thirty two to
twenty sign Road. All the clinics are very very nice,
very very cool. I hope you get a chance. I
know occasionally doctor Hamkiss well the open houses and other
events if you haven't had a chance to check them out.
They are very very nice facilities with fantastic doctors. Eight
physicians at Advocate MD of course a great model. If

(00:43):
you haven't investigated or looked into direct primary primary care
and Advocate MD, today is the day to do it.
I learn more online Advocate to DPC dot com. It's
Advocates DPC dot com. Or to make an appointment to
become a member at Advocate MD, I'll get to pick
up the phone, give a call six eight to two,
six eight, six to eleven that's six eight two six
eight sixty two eleven and I doctor, I drank my

(01:05):
coffee a little bit later this morning, and it seems
like it's catching up with me right now. How you doing.

Speaker 2 (01:10):
I'm doing well, John, I'm ready for the weekend.

Speaker 1 (01:12):
I'm absolutely in that same boat with you. And uh,
we're gonna do a bit of a did you know
this week? And you and I we were kind of
chatting offline earlier this morning about about something that's gonna
be happening when it comes to government subsidies for ACA
and what that means for some folks that that are

(01:33):
that have subsidized plans through the Obamacare through the through
through the Obamacare program. It's interesting that that. I think
sometimes there's a bit of a disconnect about what that
is and what that is subsidizing and uh, and sometimes
it puts people in kind of a weird position, like
like if you understand, you're like, wait, why we're paying

(01:55):
all this money for what? But let's talk about Uh,
this example that you aired with me this morning, story
about about a woman whose premiums are going from expect
to go currently eight eight four hundred and eighty three
dollars up to like twenty eight hundred dollars. What is
going on there? Doctor? What do we need to talk
about and who's the real winner in that type of scenario.

Speaker 3 (02:19):
Yes, so this was a very recent story on NPR
in the online part of NPR Wisconsin. And you know,
so the the Affordable Care Act which sometimes sometimes we
also refer to that as healthcare dot gov or the
healthcare marketplace. So this is, you know, when Obamacare came

(02:39):
into practice, and you know what ended up happening initially
is that a lot of those premiums were hired than
what people expected or were hired than what people caramed for.
So they started offering insurance company subsidies federal you know,
government subsidies, which and I think, like as you said, Sean,
sometimes there's a disconnect that it's so the federal government

(03:01):
is subsidizing this. Where do you think the money comes
from that the federal government has, right, it comes from
you and me. Right, it comes from taxes and all
of these other programs, but essentially, on a very basic level,
it is funded through US. So we are funding these
insurance policies or these subsidies to the insurance companies.

Speaker 2 (03:20):
So you know, you know.

Speaker 3 (03:22):
In some ways, yes, I think it's a it's a
good thing that that people can afford health insurance. But
in other ways, some of these plans are really crappy plans, right,
So it's like, you know, maybe it's a five hundred
dollars a month plan, but it's a ten thousand dollars
deductible with a cope and you know, so it's it's
you know again, it gives you this false sense of
security of like, oh, I have health insurance. This is great,

(03:44):
but you know it again, how many people can pay
the ten thousand dollars deductible if something you know, major
came up. So the example, as you mentioned was there's
they gave two patient examples. One was an older lady
who lives in I think West Virginia and so her
subsidized you know, coverage through the Affordable Care Act through

(04:05):
the healthcare marketplace is four hundred and seventy nine dollars
a month. But they're projecting, so there are federal grants
right now again that are funding these. So basically it's
not that you know again, it's not that the insurance
companies are saying, hey, we just want to be nice,
you like let's drop our prices by half, or let's
just charge a third of what we normally charge, you know,

(04:25):
all the other people out there. No, that's not what's happening.
The federal government again, you know, tax payers or you
know how every one of view this is paying insurance
companies subsidies so that they will build a lower rate.

Speaker 2 (04:38):
On you know, the marketplace.

Speaker 3 (04:39):
You know, if you're a very cynical person, you could
say this is kind of you know, smoke and mirrors,
so that it appears that healthcare dot gov is offering
like all these wonderful prices, like oh this is you know, wow,
I didn't realize I could get health insurance for such
an affordable price. But behind the scenes, we are paying
for this, right, It's just being paid for it in
a little bit different way and a little bit less

(05:00):
transparent way. Right, So, so you know, taxpayers still are
putting the bills for these you know, exorbitant you know,
healthcare premiums. So that example, where her insurance is going
to go up from four hundred and seventy nine dollars
to where she said it was going to have, it
was estimated to go up to twenty eight hundred dollars

(05:22):
a month, so twenty eight hundred dollars a month.

Speaker 2 (05:24):
Stown that means that.

Speaker 3 (05:26):
It's what is that like thirty four thousand dollars a year?
You know, how many people can afford to pay thirty
four thousand dollars a year for their health insurance coverage?

Speaker 1 (05:37):
What's what and what's alarming about that, doctors is you know,
you think about the monthly coverage. Then you mentioned earlier
about that ten thousand dollars deductible. And for folks that
are that are accessing these subsidized plans, part of why
they're accessing them is they're you know, their their lower
income folks that that are our need in need of assistance.

(05:58):
And then I think, well, how can you afford that
monthly premium there? And if you are able to afford
that monthly premium, how are you able to pay that
ten thousand dollars deductible? So you're paying into it and
then you've got to go to the doctor for something, well,
you know, you probably don't have ten thousand dollars sitting
around to eat up before we start getting any of

(06:20):
that coverage. And then you're like, well is that really
you know, at the end of the day, What are
they really doing. They're just they're paying a monthly fee
and then maybe, if they're lucky, they're using that they're spending,
they have the ten thousand dollars and maybe then at
that point they'll be able to access to me doctor.
And one of the things that that it really kind
of drives me kind of a little crazy and frustrates

(06:42):
me and also saddens me, is you know, people in
this position, you know, we're not. I love the idea
of people getting help and making sure that people have
health coverage. What frustrates me is is in having talked
with you over the years, learning about all of the
like accesses and like where this money is going. It
would be great if this money was you know, if

(07:03):
we had a like direct primary care. Great example, money
we're going to the doctors for treatment and care and
going to things that are needed to treat and care people.
And unfortunately the insurance companies it's not where the money
is going. A lot of it's going to build beautiful
buildings and pay great salaries and buy nice cars and
airplanes and helicopters and other things that really don't benefit healthcare.

(07:24):
So yeah, and that.

Speaker 3 (07:26):
Was the trux of you know what essentially was a
lot wrong but with the Affordable Care Act and why
a lot of people don't like it or didn't like
it is it didn't really solve any problems.

Speaker 2 (07:39):
Right.

Speaker 3 (07:39):
It subsidized the system that was already broken. Right, So
the insurance based healthcare system is broken. I mean, it's
broken for many reasons. Costs is obviously one of them.
So it put a band aid on it by making
it appear as though people were getting better health insurance prices,
and therefore people that were uninsured can now afford health insurance. Again,
you can make it argument as to whether or not

(08:01):
that's actually health care and whether they actually have access
to healthcare. And as we talked about last week on
the program, you can have a health insurance you know,
planned right here in town in Madison, Wisconsin, and you
call to make an appointment with a doctor and they
tell you they're not taking any new patients or it's
nine months to get an appointment. So again, then what
is your health insurance good for if you can't actually
see a doctor. But but yeah, so it put a

(08:24):
band aid. It didn't actually fix, you know, our healthcare
delivery problem. And as you said, it didn't fix the
problem that you know, thirty to fifty percent of healthcare
right now is waste, you know, insurance billers and coders
and healthcare administrators and hospital administrators and all these layers
of bureaucracy and within the government, all these layers of

(08:46):
bureaucracy within the Medicare and Medicaid system. And you know,
there is a lot of fraud that happens. You know,
sometimes I hear people talk and you know, and luckily,
you know, we're seeing now the Department of Justice cracking
down on some of this fraud.

Speaker 2 (08:59):
But yes, there's tons of that happens.

Speaker 3 (09:01):
With Medicare and Medicaid, you know, within our healthcare system.
So who pays for all of that? We pay for that,
right because these are all government funded programs, and we
fund the government. So so yes, I think that it's
it's kind of I think you mentioned this offline a
little bit. Shron is like one of these things where
like do we let the whole system, you know, burn
down to the ground so we can create something better.

(09:24):
And I don't mean that in a kind of a
contrite way to say, like I want patients to not
have health care and not at all. You know, I
think everyone needs to have access, you know, no matter
what your socio, you can on this level, no matter
what your situation is, everyone needs to have access to care.
And again I would argue that in many cases you
can have great access to care through direct primary care.

Speaker 2 (09:45):
We don't cover.

Speaker 3 (09:46):
Everything, of course, we don't do surgeries, we don't do hospitalization,
we don't do you know, cancer treatments. You need to
have some additional level of coverage for those catastrophic things.
But for you know, ninety percent of things, you know,
you can have very affordable care, great access, great quality
care through a direct primary care and that's going to

(10:07):
lower cost.

Speaker 2 (10:07):
You know.

Speaker 3 (10:08):
Again, if more people knew about this, if more people
had access to it within their communities, and I think
that is growing, you know. And then the other kind
of example that they gave in this article, a second
patient example. This was a middle aged guy that has
a few chronic medical issues. I thought it was a
little bit funny and they quoted him in this article

(10:29):
as saying, I have diabetes, I have conjes aparpailiar, just
your normal overweight American like everybody else.

Speaker 2 (10:36):
In a little in a little bit of a way.

Speaker 3 (10:38):
I'm like, definitely true that there are a lot of
overweight to Americans, but I kind of was thinking to myself, not,
I mean not your normal cost a particular and diabetes.

Speaker 2 (10:47):
I don't necessarily I hope.

Speaker 3 (10:48):
That's not the new normal, right, but but it's it
is sad and then and again, you know, it's like
one of these things where you know, me and you
and everybody else that pays taxes in many ways, we
do pay for it unhealthy population. Right, So like if
if people uh, you know, smoke or eat to excess
or have a lot of chronic medical issues that are

(11:08):
related to lifestyle, you know, that is that is going
into the greater healthcare ecosystem, the greater you know, healthcare expenses.

Speaker 2 (11:18):
And you know, because of.

Speaker 3 (11:19):
Exactly like this article where the federal government subsidizes health
insurance premiums. So when the cost and as we know,
health insurance premiums are based on you know, overall healthcare spending.
So like as things become more expensive, claims become more expensive.
The hospital charges more for the surgery, the hospital charges
more for the MRI, the specialist charges more for their

(11:40):
part of it. You know, all of that has passed
on to the healthcare consumer in the way of premiums.
So you know, again it's not to say I think
some people have this idea, and I've even heard insurance
brokers say this, and I cringe a little bit of like, oh, well,
they're protected. You know, they've got these health insurance premiums,
so like all those costs on the back end, they
don't have to worry about that, like they're paying their
health insuran and fryment. Like, no, actually, you do worry

(12:02):
about it a lot because those costs will be passed
on to them the following year. Right, So so it's
you know, we all pay for this. You know, that's
why it would be better in an ideal world if
you know, if I can control the world, you know,
everybody's healthier, everybody has access to care. You know, we
all focus on lifestyle medicine and preventive care. We don't

(12:23):
focus you know, we don't hand out pills and injections,
and you know, we we try to get people to
eat better, to exercise more. And obviously this is very
simplistic and idealistic, but but we do all kind of
pay a part in this healthcare environment.

Speaker 1 (12:37):
You know, one of the things is you talk about,
you know, encouraging folks to do better for their health
and do better by their lifestyle. Unfortunately, in that insured system,
you know, we talk about the weight to get in
to see your primary care doctor if you're even able to,
and when you do, there's not the time to do that.
I think one of the really cool things about direct
primary care and what you're able to offer an Advocate

(12:57):
MD is not only can you get in to see
your doctor when you need to see them, if you're
not feeling well or have other type of medical concern,
you can actually get in to see your doctor, but
also when it comes to having your your checkups and
other things, getting to know your doctor and actually having
like a sincere valuable conversation that leads to things and
solutions to simple things like yeah, diet, exercise, What are

(13:19):
some manageable things that you can do to help that
stuff where you actually have the time to work with
somebody on that stuff. And that's one of the things
you think about. Some of the great features and some
of the great benefits of being a member at Advocate
mdo are those are just just some some of the
some of the things that you may not always think
about that are actually pay huge dividends and it's a
great day to become a member at Advocate MD. I'll

(13:40):
give you just pick up phone game a call six
soaight two six eight sixty two eleven. That's six eight
to two six eight sixty two eleven to make an
appointment to become a member at Advocate MD. And doctor
I mentioned that word benefits too. I want to ask
you about this is I think sometimes and it's changing.
I know people talk about, you know, when you get
a new job, get these benefits and health insurance comes
with it? Which is which is? I get it? I

(14:00):
understand why companies offer it. What people oftentimes are insulated
from is I'm not saying that it's not a big
cost for families, but people don't always fully understand how
much of a cost that insurance is not just for
you as the employee, but how much oftentimes your employer
is kicking in as well. This stuff is and I
think on some level that almost insulates people sometimes from

(14:21):
the full cost of this mediocre healthcare that they're getting
because they're oftentimes not picking up that that full for
bill for premiums. It's insurance is like stupidly expensive for healthcare.

Speaker 3 (14:36):
Very true, and I think, as you said, Sean, you know,
historically companies have paid for healthcare benefits for their employees.

Speaker 2 (14:43):
You know, is this has.

Speaker 3 (14:44):
Changed in the last ten or twenty years, but still
the majority of Americans, I think it's like fifty five percent,
sixty percent are getting health insurance benefits through an employer plan.
You know that that might mean the employer paid one
hundred percent. That might mean in many cases the employee
is sharing that, like you know, they're paying forty percent,
the employer's paying sixty percent. You know, there's all these
different ways they can break that up. But most people,

(15:07):
if they work for a company that has more than
fifty employees, it's not a really small business. Their employer
is required by law to provide them some sort of
health care benefits. And as you said, Sean, in some ways,
that you know, almost makes it a little less transparent
of how much the cost of these things are. And

(15:27):
even you know, some employers are really good about educating
their employees and kind of letting them how it works
and how those costs are shared and when the cost
increase year after year, so you know, we know. I mean,
we see this with our employer groups that we work with,
that health health insurance premiums. And again, this is what
the employer side is seeing, you know, as opposed to
even on the individual side it could be even worse.

(15:49):
But on the employer side, they're seeing ten, fifteen to
twenty percent. I heard from someone yesterday that they had
a forty percent increase. So imagine you have you know,
two two hundred five hundred employees and you're spending you know,
I don't know, two or three million dollars a year
on just the health insurance part of it, and they
come back to you and say, we're going to increase

(16:10):
that by twenty percent. So I mean, we're talking about
big numbers here, And I think from the employee perspective,
you know, I think a short sighted way to view
this is like, oh, well, you know, just keep paying,
just keep paying for the insurance premiums, like I don't
have to worry about any of this. And again, this
is kind of the same a little bit of the
same comparison to the yes, you need to worry about

(16:32):
the insurance premiums even though you're not paying, you're not
seeing all of those costs that the insurance company is covering,
because in reality, you're still covering those costs, right, it's
it's going to get paid by you, either on the
front end or the back end.

Speaker 2 (16:44):
Same thing with the employer.

Speaker 3 (16:45):
So like if the employer, you know, sometimes they're self funded,
which means they pay out their own claims. Sometimes they're
fully insured, meaning that they have purchased a courts, a
D and a you know, we possibly shield policy. But
either way, whether or not they are seeing those costs
on the front end or the back end. When when
you're utilizing medical services and the cost of those services

(17:06):
go up year after year, in some cases exponentially, the
way the health insurance company recoups those costs right because
they're not losing money. I mean, look, their executives are
not taking a pay cut and saying like at the
end of the year, Oh, you know what, we didn't
make as much as projected.

Speaker 2 (17:21):
I think we're going to lower the CEO's salary by
three million dollars this year.

Speaker 3 (17:24):
No, that does not happen, right, So they pass that
you know, additional loss or whatever back onto the consumer,
back to the employer. In the way of health insurance
premium increases. So if you work for a company and
their premiums are going up by fifteen twenty thirty percent,
who actually pays for that? Your employer, Yes, but also

(17:45):
you as the employee, right because that you know, whether
that's an additional two hundred dollars three hundred dollars per
employee per month or whatever it might be, that might
mean that you know, you don't get the salary increase,
you don't get the bonus at the end of the year.
You know they can't afford to, you know, give you

(18:05):
the say, all the same benefits that they were giving
you the prior year because the health insurance costs are
so much more increased year after year. So yes, you
also as the employee will see that that will affect
the bottom line in terms of what you make and
the other benefits that you received.

Speaker 1 (18:23):
And we touched on it a bit about direct primary
care and advocate MD, and I do want to talk
a little bit more with you doctor for folks that
are hearing this stuff, and we talk about, you know,
what the reality is with ACA and and what the
cost can be for folks, and of course the great
option for you is to look into direct primary Care
and Advocate MD, and we'll talk with doctor Amkes about

(18:44):
those great options, how it's so affordable, how they're able
to offer such high quality care for such great value.
And we'll talk with doctor about that and so much more.
In the meantime, if you want to learn more, there's
a great resource Advocates DPC dot com. That's Advocates DPC
dot com. It is a great day to make an
appointment become a member at Advocate MD. There tell them
for number six oh eight two six eight sixty two eleven.

(19:05):
That's six 'h eight two six eight sixty two eleven.
We'll hear you our conversation with doctor Nicole Hempkiss of
Advocate MD next as full scope continues right here on
thirteen ten wib I thirteen ten wi b A and
full scope with doctor Nicole Hempkiss, Wisconsin's direct care doctor.
Learn more online the website ADVOCATESDPC dot com. That's ADVOCATESDPC
dot com. Great data, Make appointment become a member at

(19:27):
Advocate MD. Six oh eight two six eight sixty two eleven.
That's six'h eight two six eight sixty two eleven. And
doctor let's talk about about Advocate MD, and I think
a lot of folks are listening right now, say well,
how can I join? How do I enroll? What does
that process look like?

Speaker 3 (19:41):
Doctor? Yes, so typically people started our website advocatpc dot com.
There's a contact us button right on the top right
ish area, so that'll just ask you for your name
and your email address. You can send a little message
if you want to, if you have questions, or if
you just want to enroll, you can just say I'd
like to enroll, and then we send you an enrollmental

(20:02):
link along with a link to schedule an appointment. The
enrollment link doesn't take very long to complete, you know,
it'd ask you some basic information you can.

Speaker 2 (20:10):
Put in there if you would like to.

Speaker 3 (20:11):
Not everyone does this, but you know, some basic medical information,
you know, some basic medical history.

Speaker 2 (20:16):
We can also get that later. And then the scheduling.

Speaker 3 (20:19):
Link lets you, you know, go online and make an
appointment when as soon or as late as you would
like to. You can also call us by phone though,
if it's easy. If it's you know, you don't have
a computer easily available, or you're not very computer savvy,
you can give us a call. We can also schedule
that appointment by phone, but we do like to have
people kind of go online and enroll through that enrollment link.

(20:41):
That just helps to get all their information into our
system initially, and it doesn't take very long to come
in for a visit, you know. Usually sometimes it could
take a few days. Sometimes it could take maybe one week.
Two weeks is usually our tops in terms of how
long it takes to get an appointment. Because right now
we have four doctors in our practice, so basically half

(21:02):
the doctors in our practice that.

Speaker 2 (21:03):
Are still accepting new patients.

Speaker 3 (21:06):
So doctor Christina Qually who's primarily down in Janesville, Doctor
Jennifer Philbin who's at our East Madison location, she also
works one day out of Fitchburg and one day out
of Janesville. Doctor Julia Dance, who is mainly in the
Middleton location but works one day in Fitchburg and one
day in Janesville. And then doctor Gina di Giovanni, who

(21:26):
is also at our Middleton location mainly, but she works
one day in Fitchburg and one day in Janesville. So
we have four docs that are all taking on new patients. So,
like I said, it's usually pretty quick and easy to
get an appointment and then when you come in, you know,
you don't really sit in the waiting room and puts
you right back into a room. You can spend forty
five minutes to an hour with a doctor, which most

(21:47):
of us have never experienced, including myself. I've never experienced
my life, and I'm a doctor. The only I compared
to I remember in residency, we had a Geriatric Medicine
program M, and so we did these geriatrics visits where
you know, I'd be you know, certainly elderly people that
had a lot of chronic medical issues, and we'd set
aside an.

Speaker 2 (22:08):
Hour for those visits. And that's the only thing I
can remember.

Speaker 3 (22:11):
And that's an academic facility, which so this stuff doesn't
really exist very much anymore. But so in the insurance
based system, this doesn't really exist. So you know, spend
an hour with your doctor. You know, if you need
prescriptions refilled, if you need you know, preventive care stuff
that needs to be done, and then if there's ever
you know, one of the other questions we get is,
you know, what happens if there's something beyond the scope

(22:33):
of your practice, you know, if we need to refer
you either for a radiology test if you need to
see a specialist, and of course that's something we discuss
with you. We help you figure out where you need
to go for those things. That's why we do, you know,
in many cases recommend that you have some sort of
a catastrophic policy so that if you needed something beyond
our practice, you have coverage for that.

Speaker 2 (22:55):
But then if it you.

Speaker 3 (22:56):
Know, many things like MRIs, you know, again, even seeing
a specialist in an office visits. All of those things,
if you pay cash, are extremely affordable, and we help
you to figure out the places to go for those things.
So it's up to the discretion of the patient whether
they want to go to a cash based facility and
pay cash for that versus go into the big hospital
system and use their insurance. And we're happy to send

(23:18):
the referral anywhere the patient wants.

Speaker 1 (23:20):
It's great having a doctor that advocates for you, and
of course it's a great thing about Advocate MD where
patients are the priority. You can learn more online all
sorts of great information Advocates DPC dot com. That's Advocates
DPC dot com. You can also enroll and become a
member on the website or if you prefer as doctor
Hempkiss mentioned some folks saying, you know what, I'd rather
do it over the phone, set up the appointment, become member.

(23:40):
All you gotta do is pickup pone, give a call
six oh eight two six eight sixty two eleven. That's
six oh eight two six eight sixty two eleven and
again online Advocates DPC dot com. Doctor Hempkiss, it's always
great chatting a lot of great information as always. Enjoy
the weekend and we'll do it all again real soon
you too.

Speaker 2 (23:56):
Shun talkson News

Speaker 1 (23:57):
Is next here on thirteen ten Wyke