December 8, 2025 • 32 mins
SEND US A TEXT MESSAGE!!! Let Drs. Nii & Renee know what you think about the show!
The Affordable Care Act marketplace is facing a massive premium spike in 2026 — and Congress is running out of time to stop it.
In this episode of Docs Outside The Box, Dr. Nii and Dr. Renee break down exactly why ACA premiums are increasing, what happens if Congress does nothing, and how this will impact:
- Medical students
- Residents & fellows
- Early-career doctors
- 1099 independent contractors
- Locums physicians
- Patients relying on marketplace plans
Whether you buy your own insurance or you care for patients who do — this episode gives you the real-world implications and action steps you need right now.
In This Episode You’ll Learn:
✔️ Why ACA marketplace premiums could jump 40–60%
✔️ How expiring federal subsidies affect patients AND physicians
✔️ Why independent contractors will feel the biggest financial hit
✔️ The impact on hospitals, uninsured rates & ER volume
✔️ What doctors can do NOW to prepare (financial steps included)
🎧 Perfect Episode For:
- Medical students navigating their first insurance decisions
- Residents & fellows in high-deductible plans
- New attendings planning their 2026 budgets
- Locums docs & 1099 contractors buying their own insurance
- Any clinician wanting clarity on the latest healthcare policy changes
FREE DOWNLOAD - 7 Considerations Before Starting Locum Tenens - https://darkos.lpages.co/7-considerations-before-locums
LINKS MENTIONED
ACA Premium Spike Analysis — HealthSystemTracker
https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026/?utm_source=chatgpt.com
Subsidy Expiration Breakdown — Center on Budget and Policy Priorities
https://www.cbpp.org/research/health/health-insurance-premium-spikes-imminent-as-tax-credit-enhancements-set-to-expire?utm_source=chatgpt.com
Congressional Update on ACA Debate
https://cnycentral.com/news/nation-world/congress-enters-crunch-time-to-figure-out-how-to-deal-with-aca-subsidies-affordable-care-act-obamacare-health-insurance-premiums?utm_source=chatgpt.com
Independent Contractors & ACA Tax Credit Changes
https://jasonfintips.com/insurance-risk-management-blog/affordable-health-insurance-for-independent-contractors-understanding-the-new-aca-tax-credit-changes/?utm_source=chatgpt.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_03 (00:35):
There are some subsidies out there that are
helping a lot of Americans paythe premiums for their health
insurance.
So the subsidies are gonna goaway.
The same plan starting January1st that we have that we pay
$1,400 for is gonna be$1,700 amonth.
SPEAKER_01 (00:51):
My God.
SPEAKER_03 (00:51):
Nothing changes at all.
No body parts grow additionally.
SPEAKER_01 (00:54):
I might have to grow a new body part.
I'd be good with an extra arm.
SPEAKER_03 (00:57):
To some independent contractors, that's gonna eat
into their profits.
SPEAKER_01 (01:00):
Oh, victim.
You are really going to beforced to be doing business as a
business.
If your costs are going up, youreally have to see yourself more
than just as, well, I'm thedoctor and I'm here to see
patients.
You have to really startinteracting with these hospitals
as a business.
SPEAKER_03 (01:17):
On top of that, policy matters.
You're gonna be affected bythis.
Like you cannot sit on thesidelines.
And guess what?
When patients can't affordpremiums, guess what they do?
They go to the ED.
What up, everybody?
This is Dr.
Ni, joined by my co-host, Dr.
Renee.
Hope everybody's doing well.
Uh, this is our first podcastafter Thanksgiving.
(01:38):
Um, we hosted Thanksgiving, it'sbusy, um, but it's a very
important holiday for me and myfamily, uh, mainly because we
don't get together too often.
That's the one time where we allas a family get together and
have dinner, break bread.
And um, it was great this year.
Yeah, it was.
Great this year.
SPEAKER_01 (01:54):
My back was killing me.
SPEAKER_03 (01:55):
Yeah, you did a lot of cooking, and I definitely got
to appreciate you for that.
Um, big ups for you for doing umthe diriapois, for doing the
what's it, macaroni à grandin?
Everything out there for themost part um was was great.
And you did you spent a lot oftime working on it?
I appreciate you for that, yeah.
SPEAKER_01 (02:12):
Thank you.
SPEAKER_03 (02:13):
Alfred, let's get a let's get a round of applause
for her, y'all.
Please please.
SPEAKER_01 (02:16):
Yeah.
Well, you cleaned up the place.
SPEAKER_03 (02:18):
Actually, no, you didn't.
SPEAKER_01 (02:20):
What do you mean?
SPEAKER_03 (02:21):
I didn't clean up.
SPEAKER_01 (02:21):
No, I mean before, remember all the stuff
downstairs.
SPEAKER_03 (02:26):
Oh, yeah, yeah, yeah, yeah.
Because we, you know, like youfamily, all like we rarely stay
in just one place.
So I just wanted to make surethat it was comfortable for
people to roam around and go tothe basement.
SPEAKER_01 (02:36):
Yeah.
SPEAKER_03 (02:36):
Go to the bedrooms, wherever they want to.
SPEAKER_01 (02:38):
A lot of stuff in the basement.
SPEAKER_03 (02:40):
Yeah, we got to get rid of a lot of shit.
So yeah.
But that's not what we're herefor.
We're here.
SPEAKER_00 (02:44):
What are we here for?
SPEAKER_03 (02:45):
We here for well, first of all, I want to thank
everybody for tuning in onYouTube as well as on the audio
experience.
Um, I just want to say Iappreciate everyone.
We got a lot of feedback fromthe previous episode.
Really?
We had some friends even reachout just to be like, glad you
guys are back.
SPEAKER_01 (03:00):
I think people sent out an APB on us.
SPEAKER_03 (03:03):
Yeah, yeah.
We got text messages, uh, we gotquestions.
SPEAKER_01 (03:07):
Y'all okay?
SPEAKER_03 (03:08):
We got comments on YouTube that we're talking
about.
Yo, it's like that sometimes.
It's like that sometimes.
But we good.
We gonna be good, but sometimes,you know, there's a little bit
of, as they heard in theprevious episode, too many irons
on the plate.
Yes, or on the stove, excuse me.
SPEAKER_00 (03:25):
Yes.
SPEAKER_03 (03:25):
And um, just want to say I appreciate everybody for
tuning in because you know, thisis the best doctor podcast out
there, I'll tell you right now.
SPEAKER_00 (03:33):
You better be.
SPEAKER_03 (03:34):
And we keep it real.
SPEAKER_00 (03:35):
You better, you better keep it real.
Yeah.
SPEAKER_03 (03:37):
So let's let's talk about real quick, briefly, what
we're gonna talk about today.
We're gonna talk about how theAffordable Care Act premiums
that are gonna skyrocket in lessthan a month, how it's gonna
affect us, how it's gonna affectthose who are listening right
now, and how it's gonna affectyour patients.
We're gonna answer a questionfrom someone who wrote us a
very, this is not astraightforward question.
This is more of like a black andwhite in one respect, and then
(03:59):
it's more of an emotionalquestion on the other.
Um, basically, it's about howPSLF and being a first
generation immigrant and beingthe only doctor in your family,
how that all relates and tracks,and then that's pretty much it.
We're gonna get out of hereafter that.
SPEAKER_01 (04:14):
Okay.
SPEAKER_03 (04:14):
All right.
Um, so let's jump into this.
So let's talk about ACApremiums.
Um, if you guys have been livingunder a rock, for those who've
been living under a rock, um,the reason why, the main reason
why um the government went intoa shutdown is there's going to
be or there are some subsidiesout there that are helping a lot
of Americans pay the premiumsfor their health insurance.
(04:38):
And a lot of these folks gettheir health insurance through
the Affordable Care Act, throughthe marketplace, Obamacare,
whichever word you want to use,um, if you're getting health
insurance not through youremployer, that's what the
Affordable Care Act kicks in.
That's how we as a family, yeah,since 2017, that's how we as a
family get our health insurance.
And basically we go on awebsite, we go onto New Jersey's
(05:00):
website because we live inJersey, and we look at all the
different health plans.
And it's just like anybody who'sworking right now and they have
different tiers.
They have a bronze plan, theyhave a silver tier, and then
they also have a gold plan.
And that's it.
You pay your insurance.
For those who are independentcontractors, the 1099 docs out
(05:21):
there, um, for even yourpatients, what ends up happening
is you get some type of subsidyif you are a patient for the
most part.
If you're an independentcontractor, for example, if
you're a doctor, you probablydon't qualify for a subsidy to
pay for your premium, but um itthere's a significant portion of
(05:42):
that premium that you pay thatis tax deductible.
SPEAKER_02 (05:45):
Right.
SPEAKER_03 (05:46):
Because the IRS looks at that as the cost of
doing business.
In order for you to work andprovide your services at a
hospital, you gotta have yourown health insurance.
Right?
You are an employer.
SPEAKER_01 (05:56):
Nobody else is giving it to you.
SPEAKER_03 (05:57):
Right.
So those premiums and thosesubsidies are gonna go reverse.
So the subsidies are gonna goaway starting January 1st.
So that means that a lot ofpeople are gonna be paying a
shit ton of money now.
SPEAKER_02 (06:09):
Boom.
SPEAKER_03 (06:10):
The premiums are gonna go through the roof.
And I'll just start with us.
Actually, let's just be a modeof transparency.
Um, so right now we're in openenrollment.
By the end of this month, we'vegot to make a decision on our
healthcare coverage.
Um, so if you go to New Jersey'swebsite, we currently play pay
$1,400 a month for our healthinsurance, which a lot of people
(06:31):
are like, good lord, that's alot of money.
Especially if you're employed,right?
Your health insurance costs thesame amount, but your job is
probably paying either all or50% of it.
50% of it, 60% of it.
It's part of your fringebenefits.
Right.
Right.
And then you pay a premium outof your paycheck.
That's how it works.
So that's why you probably areused to seeing like$300 or$400
(06:53):
or$500, depending on how manykids you got, right?
I can make a joke there, butdepending on how many kids you
got.
What joke?
I don't know.
Follow me.
If you got a lot of kids, thenprobably your premiums are a
little bit higher.
If you don't, your premiums area little bit lower.
But either way, we pay$1,400 amonth.
So I went to the website tostart enrolling us in for making
(07:14):
sure we have a new plan becauseI'm also considering, you know,
the kids are eight and six now.
They're not going to the doctoras much, but because they're
eight and six, they get onbicycles, they do a bunch of
stupid shit, the likelihood ofthem going into the hospital and
getting hurt.
Right.
Our kids are entering into thatappendectomy stage.
You know what I'm saying?
Like they are, all of thosedifferent things are starting to
(07:36):
come up.
SPEAKER_01 (07:36):
Sorry, I'm laughing because when I was little, when
I was about nine or so,something happened with my dad's
job or whatever, and we didn'thave health insurance.
Oh, yeah.
And he'd be like, go inside.
We don't have any healthinsurance.
Don't cost us no money.
Don't go falling outside.
Go inside.
Don't play outside.
SPEAKER_03 (07:57):
And back then there was no urgent care.
There was just the ER.
Just the ER, y'all.
I remember a bike fell on myhead.
You be good.
Tussing.
Put some tussing on.
You'd be all right.
I actually needed stitches, butOkay, mom and dad will do it for
you.
SPEAKER_00 (08:11):
No.
They took me to the ER.
SPEAKER_03 (08:13):
No word.
Get the janitor to do it.
Even the janitor's prices aretoo high.
SPEAKER_02 (08:20):
You know?
SPEAKER_03 (08:22):
Well, listen, um, I was there too back in 1988 when
my dad lost his job on BlackFriday.
Was it Black Friday?
Black Monday.
SPEAKER_01 (08:29):
Black Monday.
Yeah, Black Monday.
Was it Black Friday is when youbuy stuff.
SPEAKER_03 (08:33):
Yeah, I think it was Black Monday.
SPEAKER_01 (08:34):
He definitely didn't buy nothing on Black Friday if
he lost his job.
SPEAKER_03 (08:37):
Yeah, so he he lost his job and we same thing.
Um had the same discussion.
Hey, we ain't got no healthinsurance.
SPEAKER_01 (08:44):
Go inside.
SPEAKER_03 (08:44):
Stay inside, yeah.
SPEAKER_01 (08:45):
I think he was in the immigrants uh guidebook to
survival.
SPEAKER_03 (08:50):
But so I went online to look at our health insurance
because I'm thinking aboutincreasing the premiums.
But if we stay at our currentwhat we have, which is the
bronze tier plan.
And the reason we do bronze tieris because we want to have a
high deduct.
We want to have a highdeductible plan.
Basically, we don't anticipateusing the medical system.
So we say, look, we'll have ahigh deductible.
SPEAKER_01 (09:13):
We don't anticipate using it as much.
SPEAKER_03 (09:15):
What did I say?
SPEAKER_01 (09:16):
We don't anticipate using the medical system.
SPEAKER_03 (09:19):
Okay.
Well, we don't we don'tanticipate you guys know what
I'm talking about.
They get what I'm saying, right?
SPEAKER_02 (09:25):
Okay, I just want to make sure.
SPEAKER_03 (09:27):
So as a result, our premiums are lower, right?
But if something were to happen,we would pay a little bit more
than somebody else who payshigher premiums.
Right?
My I'm tracking, right?
SPEAKER_02 (09:40):
You're tracking.
SPEAKER_03 (09:41):
So the same plan starting January 1st that we
have that we pay$1,400 for isgonna be$1,700 a month.
SPEAKER_01 (09:48):
My God.
SPEAKER_03 (09:49):
Nothing changes at all.
No body parts grow additionally.
It's the same thing.
SPEAKER_01 (09:53):
I might have to grow a new body part.
SPEAKER_03 (09:55):
Well, that's$300 a month overnight.
I'd be good with an extra arm.
That is a 21% uh jump um in ouruh deductible or in our
premiums.
Um so I'll just tell you rightnow, like, it's not just us.
So any of the healthcareprofessionals who are listening
who are independent contractors,uh those independent contractors
(10:17):
who are not in healthcare, youknow, those um what do you call
it?
Plumber, consultants, whateverit may be, um there's some
residents who are in highdeductible health plans, right?
So they're like, well, I don'tsee the doctor much.
I'm young, you know.
They're going to see an increasein their premiums.
Patients are going to see anincrease in their premiums.
So it's not just us.
So we just wanted to share thatit, you know, it it's affecting
(10:39):
us, but it's also gonna beaffecting you also.
SPEAKER_01 (10:41):
Yeah.
SPEAKER_03 (10:42):
Right.
Um, so that's that's um that'sgonna be a problem.
Uh now we can handle that,obviously, right?
But it's some to someindependent contractors, that's
gonna eat into their profits.
SPEAKER_01 (10:54):
Oh, big time.
SPEAKER_03 (10:55):
That'll eat into your profits.
Um, and that might even causesome of y'all to come back to
the negotiating table with somehospitals and be like, yo,
you're gonna have to pay me alittle bit more to offset the
fact that I have higher costs.
SPEAKER_02 (11:06):
Right.
SPEAKER_03 (11:07):
So that may or may not put you in a good position,
though.
We'll see.
We'll see.
SPEAKER_01 (11:11):
Yeah.
Yeah.
I think Well, I mean, I thinkthat you're going to be much
more forced, especially asphysicians who are doing locums
independent contracting, you arereally going to be forced to be
doing business as a business,right?
Because this is what happenswhen you have businesses that
(11:32):
have costs that increase.
SPEAKER_02 (11:34):
Yeah.
SPEAKER_01 (11:34):
Right.
When everybody's talking abouttariffs, tariffs.
It's like, well, who's payingthose tariffs?
Because guess what?
These businesses aren't going tonecessarily take on all of the
costs.
So it's going to be kind of thesame thing.
If your costs are going up as anindependent contractor, you
really have to see yourself morethan just as, well, I'm the
doctor and I'm here to seepatients.
(11:55):
You're gonna have to reallystart interacting with these
hospitals as a business.
SPEAKER_03 (12:02):
Well, I I agree with what you're saying.
I think even on top of that,policy matters.
Right?
Like you, I think the folks whoare listening right now, if
you're an independentcontractor, or all you guys
right now, whether you're aresident and so forth, you're
you're gonna be affected bythis.
So policy matters.
Like you cannot sit on thesidelines and either like not
(12:22):
pay attention because in someform or fashion it's gonna
affect you.
It's gonna affect you as alocums doc.
It's gonna affect you as anemployee doc, it's gonna affect
your patients.
And guess what?
Like when patients don't havecan't afford premiums, guess
what they do?
Guess where they go?
They go to the ED.
So the whole point of theAffordable Care Act was to get
them, you know, basic healthinsurance so that they can go
(12:45):
and see a PCP.
Right.
So they're not in the ED asmuch.
So they could go to urgent care,right?
So this is all financiallyfeasible.
Now, all of a sudden you'retelling me, well, it costs way
too much for me to pay for myhealth insurance.
I'll just do what I did before,or I'll do what someone else
used to do, which is look, theER is my PCP.
Right.
Right.
So that's that's the problem.
(13:05):
Like the the decisions or theinaction of Congress, it has
real real effects on us.
And we've had to have, or we'regonna have to have a
conversation as to how we'regonna budget a little bit
better.
Because I I know you guys arelike, well, you guys are two
physicians, y'all got this andso forth.
Yo, this stuff has real effects.
Yeah.
This has real effects, realconsequences, right?
For two docs who use you knowwhat we get paid to not only
(13:30):
keep the household going, butdon't forget, like, we got
retirement plans, we got all ofthese different benefits that if
you are employed right now andyou don't necessarily have to
worry about, we have to worryabout.
SPEAKER_02 (13:39):
Right.
SPEAKER_03 (13:40):
Right.
And I think the majority ofsmall businesses or small
business owners would have toworry about also.
So that's just one thing thatyou know is a little bit
frustrating.
Um, so I just wanted to pivot,and some people may be
listening.
Well, I get what you're saying,but tell me why.
So I had to keep notes and I hadto look it up because this stuff
(14:01):
is a little bit confusing.
So I had to keep notes.
So the the point that I want tomake is what's actually causing
the premium spike.
So the first one is a lot ofthese subsidies that came into
place were around COVID.
They're set to expire.
And Congress is having a hard,well, Congress is deciding not
to renew those subsidies.
(14:22):
And as a result, the subsidiesgo down, more of the costs fall
on the patients, more of thecosts fall on us.
Premiums are gonna go throughthe roof.
SPEAKER_00 (14:29):
Right, right.
SPEAKER_03 (14:29):
Right.
Second, as always, what's alwaysrising?
Healthcare.
SPEAKER_00 (14:34):
Healthcare.
SPEAKER_03 (14:35):
Healthcare is always rising, the drug prices, how
long, how much it costs to stayin a hospital.
Yeah.
Um, the operating costs for thehospitals.
Don't forget the one bigbeautiful bill took a bunch of
money from particularly ruralhospitals.
So as a result, the insurancecompanies they are raising their
rates.
And then healthcare insurancecompanies are also raising their
(14:57):
rates.
So it's frustrating.
SPEAKER_01 (14:59):
Yeah.
SPEAKER_03 (15:00):
And then insurance companies also on top of that
are gonna say that well, morepeople are using insurance, so
the utilization goes up, and whopays for it?
We do.
We do.
Right?
SPEAKER_01 (15:12):
So But what happens when what happens when all of
that falls into place and thenless people are using insurance?
SPEAKER_03 (15:20):
And look, do I look like um Kaiser or I'm like
Robert Wood Johnson?
Like But um I I do agree withwhat you're saying, right?
Like I don't know what thatlooks like.
Is there a possibility?
SPEAKER_01 (15:35):
I don't think it will look any different.
I think you know, the the thecost of everything will continue
to go up because let's face it,the cost of things don't
typically go down.
No, right?
So the cost of things typicallygo up.
Um and no matter what theutilization is, right?
(15:55):
At least in this realm, right?
We're not we're not talkingabout, you know, six CD
changers, right?
Where yeah, the cost is gonna godown because nobody uses it
anymore because there's othertechnology.
There's no other technology thatis going to replace healthcare,
right?
The need for healthcare.
So the cost is going to continueto go up because there is
(16:17):
literally no other way for it togo.
SPEAKER_03 (16:20):
Well, the other thing is there's no checks and
balances on it, right?
There's a famous Vox, I gottafind it.
There's a famous Vox video whereI don't know if you remember
this, he's a Vox journalist,he's married, his wife is about
to have a child, and he decidedto do a social experiment where
he called the insurance company.
Yes, and he wanted to knowwhat's the upcome upfront cost
(16:41):
of this delivery.
SPEAKER_01 (16:42):
Yes.
SPEAKER_03 (16:43):
So there's there's literally no way for me to
discover what the cost is untilafter I buy it.
Is that right?
Didn't I keep that informationon hand?
Everything is processed after.
They couldn't give him astraightforward answer.
Literally, they didn't even knowwho to send him to first.
SPEAKER_02 (16:59):
Yeah.
SPEAKER_03 (16:59):
So he tried going to an insurance company.
They were like, We're sendingyou back to the hospital because
it's all about how much thehospital is gonna charge us.
SPEAKER_02 (17:07):
Right.
SPEAKER_03 (17:07):
And then he started finding out, like, you know, the
whole thing that we all learnabout in med school that a
Tylenol pill is what, a hundreddollars.
SPEAKER_01 (17:15):
You don't learn that in med school.
SPEAKER_03 (17:16):
I heard it in med school, though.
SPEAKER_01 (17:17):
You might have heard it, but we don't learn it.
SPEAKER_03 (17:21):
All right, you may be right.
SPEAKER_01 (17:22):
Okay, like they'll teach us no prices of anything
in med school.
SPEAKER_03 (17:26):
Maybe right.
SPEAKER_01 (17:27):
Yeah, not maybe.
SPEAKER_03 (17:28):
So everything is inflated.
Um, but he ended the video bylike he just had to estimate.
SPEAKER_01 (17:34):
Right.
He had to just don't know.
The you know, the only way toknow what you're going to pay
for a hospital say, like, let'ssay a delivery in a couple of
days postpartum, is you have tolook at other people who had
similar, you know, situations asyou and then see what they paid
(17:58):
and then estimate on average howmuch that might be for you.
That I think that's literallythe only way to do it.
Because they can't they theycan't tell you.
You're about to embark.
Rem remember, and I think welearned this, we might have
learned this when we weregetting our MBAs, but healthcare
is one of the only, if not theonly industry where you consume
(18:21):
something without ever knowinghow much it's going to cost you
up front.
You you just don't know.
So you have no clue what you'regetting yourself into.
SPEAKER_03 (18:33):
You know, here in the United States.
SPEAKER_01 (18:35):
Here in the United States, well, that's yeah.
SPEAKER_03 (18:36):
Well, I mean, we're just we've been we've been to
Ghana where before you get amedical procedure done, they can
give you, they have an Exceldocument or they have
tabulations that can tell youyou need appendectomy, this is
how much anesthesia is gonnacause, this is how much you know
the surgical procedure is gonnacost, this is how much
antibiotics is gonna cause, thisis how all this is gonna cost.
This is kind of sort of speakwhere you're gonna be at.
(18:56):
Right.
So I definitely think in othercountries they're able to do it.
Here in the United States, it'sa huge conglomerate, it's a huge
They either can't or they won't.
Yeah, it's an inefficiency thatpeople profit from, and as a
result, the opacity of itbenefits somebody and they're
gonna make a lot of money fromit.
So it's not gonna get anyclearer.
SPEAKER_01 (19:13):
Can you imagine going into the supermarket and
not knowing what you're gonnapay?
Which, by the way, Alfred, ifyou could just throw in that
video that we're going to sendyou about Dr.
Nee going to the supermarket toshop for Thanksgiving and
knowing exactly what he's goingto pay before we ever get to the
(19:36):
register.
SPEAKER_02 (19:37):
What video was that?
SPEAKER_01 (19:39):
Just watch the video.
SPEAKER_02 (19:40):
Okay.
SPEAKER_03 (19:41):
That's what you're doing.
Punching around thistechnologically advanced
shopping cart.
Not only can I pay for this, orexcuse me, not only can I keep
track of what I bought, but Icould also get any coupons
available for this.
And I could pay for it, and Iain't gonna be on no damn line.
(20:03):
This is the phone.com.
SPEAKER_01 (20:05):
Let's see you pick up an item and uh let's see how
it works.
SPEAKER_02 (20:10):
Okay.
SPEAKER_01 (20:11):
So would you like some pie?
SPEAKER_00 (20:14):
Yeah.
SPEAKER_03 (20:15):
Let's do a family-sized pumpkin pie, right?
SPEAKER_00 (20:17):
Oh, you're gonna get canceled.
SPEAKER_01 (20:19):
Well, you might want to get sweet potatoes, bruh.
SPEAKER_02 (20:22):
Oh, okay.
There's a difference.
You're definitely canceled.
Alright, so the sparkle's there.
I just go.
Sweet potato pie.
Let's see.
Sweet potato pie.
Right there.
What do you think about it?
(20:43):
Oh, they got this type of shoot.
That's dope actually.
They got this shoe for that'scheaper.
Okay, you might you you might beuncancelled.
So we getting that?
No, we're not getting that one.
We're gonna get the other one.
If I want to get rid of it.
If you want to get rid of it,yeah.
SPEAKER_00 (21:00):
Oh, you just scanned it twice?
No.
Oh, okay.
It's just gone.
So it weighs it.
It doesn't buy weight.
SPEAKER_03 (21:07):
No, this camera's here.
SPEAKER_00 (21:09):
Ah, the camera.
SPEAKER_03 (21:11):
And it has a barcode there.
Yo, read the barcode.
Okay.
Are we getting this one?
SPEAKER_00 (21:16):
No, we're gonna get the bigger one from uh Costco?
SPEAKER_02 (21:19):
Yeah.
Oh, now you know.
That was fun.
That was fun.
SPEAKER_03 (21:24):
That's dad life right there.
Alright.
So let's get let's get on let'sget on my point two.
Let's get on my point two.
So point is point two is whogets hit the hardest.
Um, as you already know, Italked about in the intro, it's
gonna be patients, right?
So they may either drop coveragebecause it's gonna cost too
much, right?
Um, which means they're gonnaend up coming to the ED sicker.
(21:44):
Um they're gonna be missing awhole bunch of appointments
because all the things that werecovered before, they ain't they
ain't showing up.
So they're gonna show up in yourED.
So if you're a doctor in the ED,if you're a doctor in the ED and
you drive a lucid, your day isabout to get busier.
SPEAKER_01 (21:59):
Well, you leave that the love alone.
SPEAKER_03 (22:00):
Your day's about to get busier.
You better charge longer.
Like I'm about to have an easyday today.
Fuck out of here.
You better charge.
You ain't leaving on your end ofyour shift.
That's what's gonna happen.
So listen, um, if you're ahealthcare worker that's right.
If you're a healthcare worker,um if you're a healthcare
worker, you're gonna see yourpremiums ride, whether you're
employed or not.
They're going up, telling youit's right now.
(22:22):
So um that's a problem.
And then obviously, if you're anindependent contractor, here's
where one thing that got tothink about.
Those independent contractorswho we this is what we suggest.
Listen, if you got like threejobs, tree jobs, and you're like
juggling them, they're gonnalook at which one's gonna pay
you them them the most andthey're just gonna focus on that
one.
Okay, that's what I would do.
(22:43):
Whichever one pays me the most,that's what I'm going to.
Right.
So all these other hospitalsthat are like, oh, we're really
like relying on you to come,it's like, well, if you ain't
paying like top dollar, I can'tafford you.
Yeah, you I you can't afford me.
SPEAKER_00 (22:57):
You can't afford me.
SPEAKER_03 (22:59):
Yeah, man.
Yeah, yeah.
This this this is um it's aproblem, you know.
SPEAKER_01 (23:04):
Well, everybody's gonna end up paying more, right?
I mean, what's gonna happen isthe hospitals are gonna end up
paying more because they'regonna have to pay you know,
locums more.
And that's granted, if doctorsget on board and actually
function like the businessesthat they are, the independently
contracted ones anyway.
(23:26):
So they're they're the hospitalsare going to just have to pay
more.
So I would I honestly encourageand urge doctors, especially the
new docs out there, do yourresearch.
You know, the new docs who aredoing locums, like even if
you've been in the business fora while, you and you're new to
locums, you're new toindependent contracting.
(23:48):
I I encourage you, do yourresearch.
Do not go out there taking$90 anhour, okay, when your premium is
about to go up.
SPEAKER_03 (23:58):
I know why you're saying that because you don't
because you don't want your payto go down.
That's true, though.
That's me though.
I don't want my pay to go down.
Right, so I don't want my pay togo down.
Just get more just get straight.
Listen, y'all.
The new docs out there, yo, stoptaking these low ball prices,
yo.
You need to start negotiatingmore because what happens is you
take the cheapest price, thenyou you mess with my money.
All right.
So it's not only you screwingyourself, but you're screwing
(24:18):
me.
Yeah.
So now that prices are gonna goup, hey, the price yesterday is
not the price today.
Okay, all right?
So negotiate more.
Boom.
There you go.
Let's do some action steps.
That was one action step rightthere.
I like that.
I like that.
I like that.
So listen, this is mainly fornot the docs who are making like
over six, six figures.
Um, but I think for the docs whoare in training right now, um,
(24:41):
docs who are maybe in trainingand doing um they're doing uh
locums, right?
You can go to the website,whatever state you're in, you
can check to see if you if youhave subsidies, right?
Whatever subsidies that you maybe eligible for and they are
still out there, sign up forthem, right?
For the most part, if you'remaking over like, you know, six
(25:01):
figures, you're probably notgonna be eligible unless you
have like an adjusted grossincome which is related to how
many tax deductions you got,dependence, things like that.
SPEAKER_01 (25:10):
Why do you tap on me when you said dependence?
SPEAKER_03 (25:14):
Because you don't work.
SPEAKER_01 (25:16):
What do you mean I don't work?
SPEAKER_03 (25:18):
You don't contribute.
I don't I contribute.
You don't listen.
SPEAKER_01 (25:22):
Okay, you know what?
If that's the case, then Ireally am not gonna go to work.
SPEAKER_03 (25:27):
Okay, now I work.
All right, listen.
Um action step number two.
This is for everybody.
Listen, y'all need to startbudgeting.
That's what I'm telling y'allright now.
If you know that, for example,for us that we're gonna be more
than$300,$400 every month, youguys got to start considering
that in your calculations ofwhat you're spending on a
monthly basis.
Just keep that in mind, right?
(25:49):
So that you're ready for thesehigher premiums.
Don't forget also, there's gonnabe higher out-of-pocket costs,
also.
So you may want to buff up thoseHSAs, right?
The health spending accounts.
You may want to buff up those umFSAs, the flexible spending
accounts, also, because you'regonna be more of the
responsibility of paying foryour health care is gonna be on
(26:09):
you.
So you might as well just startplanning for that, okay?
Um, so you don't want to walkinto this blindsided, you just,
you know, someone is gonna haveto pay the piper, it's gonna be
you.
So you just want to make sureyou're saved up, right?
One thing that I looked up thatI didn't consider is this if
you're an independent contractorlistening right now, you can
(26:30):
consider a change in yourbusiness structure.
Check this out, right?
You may want to consider abusiness structure that allows
you to purchase coverage througha group plan, right?
So not as an individual, but asa group plan, such as an LLC tax
as an S-corp with at least oneemployee.
So now you're buying a groupplan, and it may just be you,
(26:52):
but the reason why is that theprice spike is really just for
individual plans.
That's what we're finding out.
The price spike doesn't affectgroup plans right now.
SPEAKER_01 (27:01):
So this this is actual, these are healthcare
plans.
SPEAKER_03 (27:06):
Correct.
Correct.
That's just some so but if youchange your structure of your
organization to be like we'regonna cover a group plan, you
might be able to get a betterbenefit.
SPEAKER_01 (27:15):
I see.
SPEAKER_03 (27:16):
Um for the employed physicians, listen, man.
Um if the subsidies expire, justmake sure, you know, there's
gonna be changes in your covereddrugs, there's gonna be premium
increases, there's gonna bedeductible increases.
Um you need to call HR, find outwhat's the scoop.
They can give you a heads up.
Okay.
And then the other thing, thisis, and I think this goes a ways
(27:39):
also, is you know, for those whoare pretty conscious with their
patients, is prepare yourpatients.
Let them know.
Let them know that, hey, um, youknow, whether you are um, you
know, if you have Medicaid orMedicare, depending on if you
deal with those type ofpatients.
Um if you have patients who havetheir own private insurance, or
(28:01):
if you have people who are smallbusiness owners, things are
gonna change and be prepared.
And um, you know, get them readyto be like, hey, listen, like,
you know, there's some optionsout there, you know.
SPEAKER_01 (28:11):
So it's I would say one other thing I would add to
that is that there are nowalternatives popping up.
SPEAKER_03 (28:20):
Oh yeah, you mentioned this.
I f I keep forgetting aboutthis, but yeah, go ahead.
SPEAKER_01 (28:23):
Yeah, there are there are healthcare insurance
alternatives that are startingto pop up.
Um and I don't know we shouldmention one in particular, but
there's um one called Indie Pop.
Um, but it it's like it's kindof like membership-based.
SPEAKER_03 (28:42):
They're not a sponsor, guys.
SPEAKER_01 (28:43):
No, they're not a sponsor.
Um but they're they are kind oflike a membership based.
They, you know, I can't explainthe whole thing um because I,
you know, I don't know all theins and outs, but people are
using it um to essentially notnecessarily purchase ACA plans,
(29:03):
right?
Or have your typical healthcareinsurance.
And people are using it forthings like surgical procedures,
office visits, urgent carevisits.
And apparently there isn't asmuch of the rigmarole of trying
to figure out, you know, am Iauthorized?
You know, do I have to get areferral?
(29:24):
Do I have to do this?
Do I have to do that?
It's much more flexible.
SPEAKER_03 (29:28):
So it's it's it's more like it's more like a
co-op.
SPEAKER_01 (29:30):
Yes.
SPEAKER_03 (29:30):
Right?
So if you depending on whichneighborhood you live in, if you
live in a nice neighborhood,there might be a co-op in your
neighborhood, which is inessence like a supermarket that
everybody contributes to.
The prices are a little bit uhmore expensive, but you get, you
know, the in essence, it's likegoing to Walmart or going to
your local supermarket, but it'sreally more mom and pop.
(29:53):
And the community benefitsbecause you know they have their
own type of supermarket.
SPEAKER_02 (29:58):
Yeah.
SPEAKER_03 (29:58):
As opposed to having a big box company come in.
Now, what you're talking aboutspecifically with with the co-op
is you join a community and thenall the monies that you guys put
in gets rationed out toeverybody within the community.
SPEAKER_02 (30:12):
Right.
SPEAKER_03 (30:13):
And what they end up finding out is that these
co-ops, these communities, spendmoney better than if you went
through an insurance company.
SPEAKER_01 (30:21):
Is that like a healthcare sussu?
SPEAKER_03 (30:24):
Uh for all the immigrants, for all the West
Indians listening.
SPEAKER_01 (30:29):
You not like you know that susu life.
You know that susu life.
SPEAKER_03 (30:34):
Explain what a susu is for those who ain't who ain't
from the Caribbean, please.
SPEAKER_01 (30:38):
So a susu is essentially uh it's kind of like
a savings uh quote unquoteaccount.
It's really not an accountbecause it doesn't go in a bank.
So you get like, let's say, fivefriends, six friends, however
many friends you have, and thenthey all put money into what
they call a susu.
Usually one person is collectingthe susu, right?
(31:01):
And you all take turnsessentially collecting the sussu
such that as everybody collects,then it goes to one person, and
then you rotate the next cycle,then all of the money goes to
the next person, then you rotatethe next cycle.
SPEAKER_03 (31:17):
When an issue happens, right?
SPEAKER_01 (31:19):
When well, it can be when an issue happens, or it can
just be when the cyclecompletes.
SPEAKER_02 (31:24):
Okay, gotcha.
SPEAKER_01 (31:25):
Right.
So after you've done six cycles,everyone should have gotten
money from the sussu.
But sometimes people be takingoff with the susu, you know what
I'm saying?
You gotta be careful about theperson who is like the first,
the third, you know, thewhatever.
If they're not the last personin the sussu, they might just
(31:46):
take off with it.
SPEAKER_03 (31:50):
So do you have any experience with susus then?
SPEAKER_01 (31:52):
No, I've never done a sustainable.
Yeah, me neither.
Specifically for that reason,because people be taking off
with the susu.
SPEAKER_03 (31:57):
Well, I'll I'll I'll preempt it with this.
Do you have you been at a jobwhere they could have been a
susu?
I haven't been at one.
SPEAKER_01 (32:03):
Oh, yeah, I've been at jobs where they could have
been a susu for sure.
SPEAKER_03 (32:06):
For sure.
Yeah, the sports authoritydidn't have one.
SPEAKER_01 (32:11):
But that is a job that could have had a susu.
You think so?
Oh yeah.
Oh yeah.
SPEAKER_03 (32:15):
Well, it depends on who's the demographic, who's the
employees of the like susu ismore of a West Indian type
thing, right?
SPEAKER_01 (32:21):
Like West Indian thing.
Yes, of course.
So But I've definitely I'vedefinitely been at jobs where
there could have been a sussu.
SPEAKER_03 (32:29):
Well, look, uh, we beat this up uh a bit.
So, guys, we're we're gonna goon to our next topic, all right?
So um the next one, the nextthing we're gonna talk about is
a question from a listenerlistener, excuse me, um, who
wants to talk about PSLF andbeing a first generation um
immigrant as well as going intomed school.
We're gonna catch you guys onthat next segment.
There are some subsidies out there that are
helping a lot of Americans paythe premiums for their health
insurance.
So the subsidies are gonna goaway.
The same plan starting January1st that we have that we pay
$1,400 for is gonna be$1,700 amonth.
SPEAKER_01 (00:51):
My God.
SPEAKER_03 (00:51):
Nothing changes at all.
No body parts grow additionally.
SPEAKER_01 (00:54):
I might have to grow a new body part.
I'd be good with an extra arm.
SPEAKER_03 (00:57):
To some independent contractors, that's gonna eat
into their profits.
SPEAKER_01 (01:00):
Oh, victim.
You are really going to beforced to be doing business as a
business.
If your costs are going up, youreally have to see yourself more
than just as, well, I'm thedoctor and I'm here to see
patients.
You have to really startinteracting with these hospitals
as a business.
SPEAKER_03 (01:17):
On top of that, policy matters.
You're gonna be affected bythis.
Like you cannot sit on thesidelines.
And guess what?
When patients can't affordpremiums, guess what they do?
They go to the ED.
What up, everybody?
This is Dr.
Ni, joined by my co-host, Dr.
Renee.
Hope everybody's doing well.
Uh, this is our first podcastafter Thanksgiving.
(01:38):
Um, we hosted Thanksgiving, it'sbusy, um, but it's a very
important holiday for me and myfamily, uh, mainly because we
don't get together too often.
That's the one time where we allas a family get together and
have dinner, break bread.
And um, it was great this year.
Yeah, it was.
Great this year.
SPEAKER_01 (01:54):
My back was killing me.
SPEAKER_03 (01:55):
Yeah, you did a lot of cooking, and I definitely got
to appreciate you for that.
Um, big ups for you for doing umthe diriapois, for doing the
what's it, macaroni à grandin?
Everything out there for themost part um was was great.
And you did you spent a lot oftime working on it?
I appreciate you for that, yeah.
SPEAKER_01 (02:12):
Thank you.
SPEAKER_03 (02:13):
Alfred, let's get a let's get a round of applause
for her, y'all.
Please please.
SPEAKER_01 (02:16):
Yeah.
Well, you cleaned up the place.
SPEAKER_03 (02:18):
Actually, no, you didn't.
SPEAKER_01 (02:20):
What do you mean?
SPEAKER_03 (02:21):
I didn't clean up.
SPEAKER_01 (02:21):
No, I mean before, remember all the stuff
downstairs.
SPEAKER_03 (02:26):
Oh, yeah, yeah, yeah, yeah.
Because we, you know, like youfamily, all like we rarely stay
in just one place.
So I just wanted to make surethat it was comfortable for
people to roam around and go tothe basement.
SPEAKER_01 (02:36):
Yeah.
SPEAKER_03 (02:36):
Go to the bedrooms, wherever they want to.
SPEAKER_01 (02:38):
A lot of stuff in the basement.
SPEAKER_03 (02:40):
Yeah, we got to get rid of a lot of shit.
So yeah.
But that's not what we're herefor.
We're here.
SPEAKER_00 (02:44):
What are we here for?
SPEAKER_03 (02:45):
We here for well, first of all, I want to thank
everybody for tuning in onYouTube as well as on the audio
experience.
Um, I just want to say Iappreciate everyone.
We got a lot of feedback fromthe previous episode.
Really?
We had some friends even reachout just to be like, glad you
guys are back.
SPEAKER_01 (03:00):
I think people sent out an APB on us.
SPEAKER_03 (03:03):
Yeah, yeah.
We got text messages, uh, we gotquestions.
SPEAKER_01 (03:07):
Y'all okay?
SPEAKER_03 (03:08):
We got comments on YouTube that we're talking
about.
Yo, it's like that sometimes.
It's like that sometimes.
But we good.
We gonna be good, but sometimes,you know, there's a little bit
of, as they heard in theprevious episode, too many irons
on the plate.
Yes, or on the stove, excuse me.
SPEAKER_00 (03:25):
Yes.
SPEAKER_03 (03:25):
And um, just want to say I appreciate everybody for
tuning in because you know, thisis the best doctor podcast out
there, I'll tell you right now.
SPEAKER_00 (03:33):
You better be.
SPEAKER_03 (03:34):
And we keep it real.
SPEAKER_00 (03:35):
You better, you better keep it real.
Yeah.
SPEAKER_03 (03:37):
So let's let's talk about real quick, briefly, what
we're gonna talk about today.
We're gonna talk about how theAffordable Care Act premiums
that are gonna skyrocket in lessthan a month, how it's gonna
affect us, how it's gonna affectthose who are listening right
now, and how it's gonna affectyour patients.
We're gonna answer a questionfrom someone who wrote us a
very, this is not astraightforward question.
This is more of like a black andwhite in one respect, and then
(03:59):
it's more of an emotionalquestion on the other.
Um, basically, it's about howPSLF and being a first
generation immigrant and beingthe only doctor in your family,
how that all relates and tracks,and then that's pretty much it.
We're gonna get out of hereafter that.
SPEAKER_01 (04:14):
Okay.
SPEAKER_03 (04:14):
All right.
Um, so let's jump into this.
So let's talk about ACApremiums.
Um, if you guys have been livingunder a rock, for those who've
been living under a rock, um,the reason why, the main reason
why um the government went intoa shutdown is there's going to
be or there are some subsidiesout there that are helping a lot
of Americans pay the premiumsfor their health insurance.
(04:38):
And a lot of these folks gettheir health insurance through
the Affordable Care Act, throughthe marketplace, Obamacare,
whichever word you want to use,um, if you're getting health
insurance not through youremployer, that's what the
Affordable Care Act kicks in.
That's how we as a family, yeah,since 2017, that's how we as a
family get our health insurance.
And basically we go on awebsite, we go onto New Jersey's
(05:00):
website because we live inJersey, and we look at all the
different health plans.
And it's just like anybody who'sworking right now and they have
different tiers.
They have a bronze plan, theyhave a silver tier, and then
they also have a gold plan.
And that's it.
You pay your insurance.
For those who are independentcontractors, the 1099 docs out
(05:21):
there, um, for even yourpatients, what ends up happening
is you get some type of subsidyif you are a patient for the
most part.
If you're an independentcontractor, for example, if
you're a doctor, you probablydon't qualify for a subsidy to
pay for your premium, but um itthere's a significant portion of
(05:42):
that premium that you pay thatis tax deductible.
SPEAKER_02 (05:45):
Right.
SPEAKER_03 (05:46):
Because the IRS looks at that as the cost of
doing business.
In order for you to work andprovide your services at a
hospital, you gotta have yourown health insurance.
Right?
You are an employer.
SPEAKER_01 (05:56):
Nobody else is giving it to you.
SPEAKER_03 (05:57):
Right.
So those premiums and thosesubsidies are gonna go reverse.
So the subsidies are gonna goaway starting January 1st.
So that means that a lot ofpeople are gonna be paying a
shit ton of money now.
SPEAKER_02 (06:09):
Boom.
SPEAKER_03 (06:10):
The premiums are gonna go through the roof.
And I'll just start with us.
Actually, let's just be a modeof transparency.
Um, so right now we're in openenrollment.
By the end of this month, we'vegot to make a decision on our
healthcare coverage.
Um, so if you go to New Jersey'swebsite, we currently play pay
$1,400 a month for our healthinsurance, which a lot of people
(06:31):
are like, good lord, that's alot of money.
Especially if you're employed,right?
Your health insurance costs thesame amount, but your job is
probably paying either all or50% of it.
50% of it, 60% of it.
It's part of your fringebenefits.
Right.
Right.
And then you pay a premium outof your paycheck.
That's how it works.
So that's why you probably areused to seeing like$300 or$400
(06:53):
or$500, depending on how manykids you got, right?
I can make a joke there, butdepending on how many kids you
got.
What joke?
I don't know.
Follow me.
If you got a lot of kids, thenprobably your premiums are a
little bit higher.
If you don't, your premiums area little bit lower.
But either way, we pay$1,400 amonth.
So I went to the website tostart enrolling us in for making
(07:14):
sure we have a new plan becauseI'm also considering, you know,
the kids are eight and six now.
They're not going to the doctoras much, but because they're
eight and six, they get onbicycles, they do a bunch of
stupid shit, the likelihood ofthem going into the hospital and
getting hurt.
Right.
Our kids are entering into thatappendectomy stage.
You know what I'm saying?
Like they are, all of thosedifferent things are starting to
(07:36):
come up.
SPEAKER_01 (07:36):
Sorry, I'm laughing because when I was little, when
I was about nine or so,something happened with my dad's
job or whatever, and we didn'thave health insurance.
Oh, yeah.
And he'd be like, go inside.
We don't have any healthinsurance.
Don't cost us no money.
Don't go falling outside.
Go inside.
Don't play outside.
SPEAKER_03 (07:57):
And back then there was no urgent care.
There was just the ER.
Just the ER, y'all.
I remember a bike fell on myhead.
You be good.
Tussing.
Put some tussing on.
You'd be all right.
I actually needed stitches, butOkay, mom and dad will do it for
you.
SPEAKER_00 (08:11):
No.
They took me to the ER.
SPEAKER_03 (08:13):
No word.
Get the janitor to do it.
Even the janitor's prices aretoo high.
SPEAKER_02 (08:20):
You know?
SPEAKER_03 (08:22):
Well, listen, um, I was there too back in 1988 when
my dad lost his job on BlackFriday.
Was it Black Friday?
Black Monday.
SPEAKER_01 (08:29):
Black Monday.
Yeah, Black Monday.
Was it Black Friday is when youbuy stuff.
SPEAKER_03 (08:33):
Yeah, I think it was Black Monday.
SPEAKER_01 (08:34):
He definitely didn't buy nothing on Black Friday if
he lost his job.
SPEAKER_03 (08:37):
Yeah, so he he lost his job and we same thing.
Um had the same discussion.
Hey, we ain't got no healthinsurance.
SPEAKER_01 (08:44):
Go inside.
SPEAKER_03 (08:44):
Stay inside, yeah.
SPEAKER_01 (08:45):
I think he was in the immigrants uh guidebook to
survival.
SPEAKER_03 (08:50):
But so I went online to look at our health insurance
because I'm thinking aboutincreasing the premiums.
But if we stay at our currentwhat we have, which is the
bronze tier plan.
And the reason we do bronze tieris because we want to have a
high deduct.
We want to have a highdeductible plan.
Basically, we don't anticipateusing the medical system.
So we say, look, we'll have ahigh deductible.
SPEAKER_01 (09:13):
We don't anticipate using it as much.
SPEAKER_03 (09:15):
What did I say?
SPEAKER_01 (09:16):
We don't anticipate using the medical system.
SPEAKER_03 (09:19):
Okay.
Well, we don't we don'tanticipate you guys know what
I'm talking about.
They get what I'm saying, right?
SPEAKER_02 (09:25):
Okay, I just want to make sure.
SPEAKER_03 (09:27):
So as a result, our premiums are lower, right?
But if something were to happen,we would pay a little bit more
than somebody else who payshigher premiums.
Right?
My I'm tracking, right?
SPEAKER_02 (09:40):
You're tracking.
SPEAKER_03 (09:41):
So the same plan starting January 1st that we
have that we pay$1,400 for isgonna be$1,700 a month.
SPEAKER_01 (09:48):
My God.
SPEAKER_03 (09:49):
Nothing changes at all.
No body parts grow additionally.
It's the same thing.
SPEAKER_01 (09:53):
I might have to grow a new body part.
SPEAKER_03 (09:55):
Well, that's$300 a month overnight.
I'd be good with an extra arm.
That is a 21% uh jump um in ouruh deductible or in our
premiums.
Um so I'll just tell you rightnow, like, it's not just us.
So any of the healthcareprofessionals who are listening
who are independent contractors,uh those independent contractors
(10:17):
who are not in healthcare, youknow, those um what do you call
it?
Plumber, consultants, whateverit may be, um there's some
residents who are in highdeductible health plans, right?
So they're like, well, I don'tsee the doctor much.
I'm young, you know.
They're going to see an increasein their premiums.
Patients are going to see anincrease in their premiums.
So it's not just us.
So we just wanted to share thatit, you know, it it's affecting
(10:39):
us, but it's also gonna beaffecting you also.
SPEAKER_01 (10:41):
Yeah.
SPEAKER_03 (10:42):
Right.
Um, so that's that's um that'sgonna be a problem.
Uh now we can handle that,obviously, right?
But it's some to someindependent contractors, that's
gonna eat into their profits.
SPEAKER_01 (10:54):
Oh, big time.
SPEAKER_03 (10:55):
That'll eat into your profits.
Um, and that might even causesome of y'all to come back to
the negotiating table with somehospitals and be like, yo,
you're gonna have to pay me alittle bit more to offset the
fact that I have higher costs.
SPEAKER_02 (11:06):
Right.
SPEAKER_03 (11:07):
So that may or may not put you in a good position,
though.
We'll see.
We'll see.
SPEAKER_01 (11:11):
Yeah.
Yeah.
I think Well, I mean, I thinkthat you're going to be much
more forced, especially asphysicians who are doing locums
independent contracting, you arereally going to be forced to be
doing business as a business,right?
Because this is what happenswhen you have businesses that
(11:32):
have costs that increase.
SPEAKER_02 (11:34):
Yeah.
SPEAKER_01 (11:34):
Right.
When everybody's talking abouttariffs, tariffs.
It's like, well, who's payingthose tariffs?
Because guess what?
These businesses aren't going tonecessarily take on all of the
costs.
So it's going to be kind of thesame thing.
If your costs are going up as anindependent contractor, you
really have to see yourself morethan just as, well, I'm the
doctor and I'm here to seepatients.
(11:55):
You're gonna have to reallystart interacting with these
hospitals as a business.
SPEAKER_03 (12:02):
Well, I I agree with what you're saying.
I think even on top of that,policy matters.
Right?
Like you, I think the folks whoare listening right now, if
you're an independentcontractor, or all you guys
right now, whether you're aresident and so forth, you're
you're gonna be affected bythis.
So policy matters.
Like you cannot sit on thesidelines and either like not
(12:22):
pay attention because in someform or fashion it's gonna
affect you.
It's gonna affect you as alocums doc.
It's gonna affect you as anemployee doc, it's gonna affect
your patients.
And guess what?
Like when patients don't havecan't afford premiums, guess
what they do?
Guess where they go?
They go to the ED.
So the whole point of theAffordable Care Act was to get
them, you know, basic healthinsurance so that they can go
(12:45):
and see a PCP.
Right.
So they're not in the ED asmuch.
So they could go to urgent care,right?
So this is all financiallyfeasible.
Now, all of a sudden you'retelling me, well, it costs way
too much for me to pay for myhealth insurance.
I'll just do what I did before,or I'll do what someone else
used to do, which is look, theER is my PCP.
Right.
Right.
So that's that's the problem.
(13:05):
Like the the decisions or theinaction of Congress, it has
real real effects on us.
And we've had to have, or we'regonna have to have a
conversation as to how we'regonna budget a little bit
better.
Because I I know you guys arelike, well, you guys are two
physicians, y'all got this andso forth.
Yo, this stuff has real effects.
Yeah.
This has real effects, realconsequences, right?
For two docs who use you knowwhat we get paid to not only
(13:30):
keep the household going, butdon't forget, like, we got
retirement plans, we got all ofthese different benefits that if
you are employed right now andyou don't necessarily have to
worry about, we have to worryabout.
SPEAKER_02 (13:39):
Right.
SPEAKER_03 (13:40):
Right.
And I think the majority ofsmall businesses or small
business owners would have toworry about also.
So that's just one thing thatyou know is a little bit
frustrating.
Um, so I just wanted to pivot,and some people may be
listening.
Well, I get what you're saying,but tell me why.
So I had to keep notes and I hadto look it up because this stuff
(14:01):
is a little bit confusing.
So I had to keep notes.
So the the point that I want tomake is what's actually causing
the premium spike.
So the first one is a lot ofthese subsidies that came into
place were around COVID.
They're set to expire.
And Congress is having a hard,well, Congress is deciding not
to renew those subsidies.
(14:22):
And as a result, the subsidiesgo down, more of the costs fall
on the patients, more of thecosts fall on us.
Premiums are gonna go throughthe roof.
SPEAKER_00 (14:29):
Right, right.
SPEAKER_03 (14:29):
Right.
Second, as always, what's alwaysrising?
Healthcare.
SPEAKER_00 (14:34):
Healthcare.
SPEAKER_03 (14:35):
Healthcare is always rising, the drug prices, how
long, how much it costs to stayin a hospital.
Yeah.
Um, the operating costs for thehospitals.
Don't forget the one bigbeautiful bill took a bunch of
money from particularly ruralhospitals.
So as a result, the insurancecompanies they are raising their
rates.
And then healthcare insurancecompanies are also raising their
(14:57):
rates.
So it's frustrating.
SPEAKER_01 (14:59):
Yeah.
SPEAKER_03 (15:00):
And then insurance companies also on top of that
are gonna say that well, morepeople are using insurance, so
the utilization goes up, and whopays for it?
We do.
We do.
Right?
SPEAKER_01 (15:12):
So But what happens when what happens when all of
that falls into place and thenless people are using insurance?
SPEAKER_03 (15:20):
And look, do I look like um Kaiser or I'm like
Robert Wood Johnson?
Like But um I I do agree withwhat you're saying, right?
Like I don't know what thatlooks like.
Is there a possibility?
SPEAKER_01 (15:35):
I don't think it will look any different.
I think you know, the the thecost of everything will continue
to go up because let's face it,the cost of things don't
typically go down.
No, right?
So the cost of things typicallygo up.
Um and no matter what theutilization is, right?
(15:55):
At least in this realm, right?
We're not we're not talkingabout, you know, six CD
changers, right?
Where yeah, the cost is gonna godown because nobody uses it
anymore because there's othertechnology.
There's no other technology thatis going to replace healthcare,
right?
The need for healthcare.
So the cost is going to continueto go up because there is
(16:17):
literally no other way for it togo.
SPEAKER_03 (16:20):
Well, the other thing is there's no checks and
balances on it, right?
There's a famous Vox, I gottafind it.
There's a famous Vox video whereI don't know if you remember
this, he's a Vox journalist,he's married, his wife is about
to have a child, and he decidedto do a social experiment where
he called the insurance company.
Yes, and he wanted to knowwhat's the upcome upfront cost
(16:41):
of this delivery.
SPEAKER_01 (16:42):
Yes.
SPEAKER_03 (16:43):
So there's there's literally no way for me to
discover what the cost is untilafter I buy it.
Is that right?
Didn't I keep that informationon hand?
Everything is processed after.
They couldn't give him astraightforward answer.
Literally, they didn't even knowwho to send him to first.
SPEAKER_02 (16:59):
Yeah.
SPEAKER_03 (16:59):
So he tried going to an insurance company.
They were like, We're sendingyou back to the hospital because
it's all about how much thehospital is gonna charge us.
SPEAKER_02 (17:07):
Right.
SPEAKER_03 (17:07):
And then he started finding out, like, you know, the
whole thing that we all learnabout in med school that a
Tylenol pill is what, a hundreddollars.
SPEAKER_01 (17:15):
You don't learn that in med school.
SPEAKER_03 (17:16):
I heard it in med school, though.
SPEAKER_01 (17:17):
You might have heard it, but we don't learn it.
SPEAKER_03 (17:21):
All right, you may be right.
SPEAKER_01 (17:22):
Okay, like they'll teach us no prices of anything
in med school.
SPEAKER_03 (17:26):
Maybe right.
SPEAKER_01 (17:27):
Yeah, not maybe.
SPEAKER_03 (17:28):
So everything is inflated.
Um, but he ended the video bylike he just had to estimate.
SPEAKER_01 (17:34):
Right.
He had to just don't know.
The you know, the only way toknow what you're going to pay
for a hospital say, like, let'ssay a delivery in a couple of
days postpartum, is you have tolook at other people who had
similar, you know, situations asyou and then see what they paid
(17:58):
and then estimate on average howmuch that might be for you.
That I think that's literallythe only way to do it.
Because they can't they theycan't tell you.
You're about to embark.
Rem remember, and I think welearned this, we might have
learned this when we weregetting our MBAs, but healthcare
is one of the only, if not theonly industry where you consume
(18:21):
something without ever knowinghow much it's going to cost you
up front.
You you just don't know.
So you have no clue what you'regetting yourself into.
SPEAKER_03 (18:33):
You know, here in the United States.
SPEAKER_01 (18:35):
Here in the United States, well, that's yeah.
SPEAKER_03 (18:36):
Well, I mean, we're just we've been we've been to
Ghana where before you get amedical procedure done, they can
give you, they have an Exceldocument or they have
tabulations that can tell youyou need appendectomy, this is
how much anesthesia is gonnacause, this is how much you know
the surgical procedure is gonnacost, this is how much
antibiotics is gonna cause, thisis how all this is gonna cost.
This is kind of sort of speakwhere you're gonna be at.
(18:56):
Right.
So I definitely think in othercountries they're able to do it.
Here in the United States, it'sa huge conglomerate, it's a huge
They either can't or they won't.
Yeah, it's an inefficiency thatpeople profit from, and as a
result, the opacity of itbenefits somebody and they're
gonna make a lot of money fromit.
So it's not gonna get anyclearer.
SPEAKER_01 (19:13):
Can you imagine going into the supermarket and
not knowing what you're gonnapay?
Which, by the way, Alfred, ifyou could just throw in that
video that we're going to sendyou about Dr.
Nee going to the supermarket toshop for Thanksgiving and
knowing exactly what he's goingto pay before we ever get to the
(19:36):
register.
SPEAKER_02 (19:37):
What video was that?
SPEAKER_01 (19:39):
Just watch the video.
SPEAKER_02 (19:40):
Okay.
SPEAKER_03 (19:41):
That's what you're doing.
Punching around thistechnologically advanced
shopping cart.
Not only can I pay for this, orexcuse me, not only can I keep
track of what I bought, but Icould also get any coupons
available for this.
And I could pay for it, and Iain't gonna be on no damn line.
(20:03):
This is the phone.com.
SPEAKER_01 (20:05):
Let's see you pick up an item and uh let's see how
it works.
SPEAKER_02 (20:10):
Okay.
SPEAKER_01 (20:11):
So would you like some pie?
SPEAKER_00 (20:14):
Yeah.
SPEAKER_03 (20:15):
Let's do a family-sized pumpkin pie, right?
SPEAKER_00 (20:17):
Oh, you're gonna get canceled.
SPEAKER_01 (20:19):
Well, you might want to get sweet potatoes, bruh.
SPEAKER_02 (20:22):
Oh, okay.
There's a difference.
You're definitely canceled.
Alright, so the sparkle's there.
I just go.
Sweet potato pie.
Let's see.
Sweet potato pie.
Right there.
What do you think about it?
(20:43):
Oh, they got this type of shoot.
That's dope actually.
They got this shoe for that'scheaper.
Okay, you might you you might beuncancelled.
So we getting that?
No, we're not getting that one.
We're gonna get the other one.
If I want to get rid of it.
If you want to get rid of it,yeah.
SPEAKER_00 (21:00):
Oh, you just scanned it twice?
No.
Oh, okay.
It's just gone.
So it weighs it.
It doesn't buy weight.
SPEAKER_03 (21:07):
No, this camera's here.
SPEAKER_00 (21:09):
Ah, the camera.
SPEAKER_03 (21:11):
And it has a barcode there.
Yo, read the barcode.
Okay.
Are we getting this one?
SPEAKER_00 (21:16):
No, we're gonna get the bigger one from uh Costco?
SPEAKER_02 (21:19):
Yeah.
Oh, now you know.
That was fun.
That was fun.
SPEAKER_03 (21:24):
That's dad life right there.
Alright.
So let's get let's get on let'sget on my point two.
Let's get on my point two.
So point is point two is whogets hit the hardest.
Um, as you already know, Italked about in the intro, it's
gonna be patients, right?
So they may either drop coveragebecause it's gonna cost too
much, right?
Um, which means they're gonnaend up coming to the ED sicker.
(21:44):
Um they're gonna be missing awhole bunch of appointments
because all the things that werecovered before, they ain't they
ain't showing up.
So they're gonna show up in yourED.
So if you're a doctor in the ED,if you're a doctor in the ED and
you drive a lucid, your day isabout to get busier.
SPEAKER_01 (21:59):
Well, you leave that the love alone.
SPEAKER_03 (22:00):
Your day's about to get busier.
You better charge longer.
Like I'm about to have an easyday today.
Fuck out of here.
You better charge.
You ain't leaving on your end ofyour shift.
That's what's gonna happen.
So listen, um, if you're ahealthcare worker that's right.
If you're a healthcare worker,um if you're a healthcare
worker, you're gonna see yourpremiums ride, whether you're
employed or not.
They're going up, telling youit's right now.
(22:22):
So um that's a problem.
And then obviously, if you're anindependent contractor, here's
where one thing that got tothink about.
Those independent contractorswho we this is what we suggest.
Listen, if you got like threejobs, tree jobs, and you're like
juggling them, they're gonnalook at which one's gonna pay
you them them the most andthey're just gonna focus on that
one.
Okay, that's what I would do.
(22:43):
Whichever one pays me the most,that's what I'm going to.
Right.
So all these other hospitalsthat are like, oh, we're really
like relying on you to come,it's like, well, if you ain't
paying like top dollar, I can'tafford you.
Yeah, you I you can't afford me.
SPEAKER_00 (22:57):
You can't afford me.
SPEAKER_03 (22:59):
Yeah, man.
Yeah, yeah.
This this this is um it's aproblem, you know.
SPEAKER_01 (23:04):
Well, everybody's gonna end up paying more, right?
I mean, what's gonna happen isthe hospitals are gonna end up
paying more because they'regonna have to pay you know,
locums more.
And that's granted, if doctorsget on board and actually
function like the businessesthat they are, the independently
contracted ones anyway.
(23:26):
So they're they're the hospitalsare going to just have to pay
more.
So I would I honestly encourageand urge doctors, especially the
new docs out there, do yourresearch.
You know, the new docs who aredoing locums, like even if
you've been in the business fora while, you and you're new to
locums, you're new toindependent contracting.
(23:48):
I I encourage you, do yourresearch.
Do not go out there taking$90 anhour, okay, when your premium is
about to go up.
SPEAKER_03 (23:58):
I know why you're saying that because you don't
because you don't want your payto go down.
That's true, though.
That's me though.
I don't want my pay to go down.
Right, so I don't want my pay togo down.
Just get more just get straight.
Listen, y'all.
The new docs out there, yo, stoptaking these low ball prices,
yo.
You need to start negotiatingmore because what happens is you
take the cheapest price, thenyou you mess with my money.
All right.
So it's not only you screwingyourself, but you're screwing
(24:18):
me.
Yeah.
So now that prices are gonna goup, hey, the price yesterday is
not the price today.
Okay, all right?
So negotiate more.
Boom.
There you go.
Let's do some action steps.
That was one action step rightthere.
I like that.
I like that.
I like that.
So listen, this is mainly fornot the docs who are making like
over six, six figures.
Um, but I think for the docs whoare in training right now, um,
(24:41):
docs who are maybe in trainingand doing um they're doing uh
locums, right?
You can go to the website,whatever state you're in, you
can check to see if you if youhave subsidies, right?
Whatever subsidies that you maybe eligible for and they are
still out there, sign up forthem, right?
For the most part, if you'remaking over like, you know, six
(25:01):
figures, you're probably notgonna be eligible unless you
have like an adjusted grossincome which is related to how
many tax deductions you got,dependence, things like that.
SPEAKER_01 (25:10):
Why do you tap on me when you said dependence?
SPEAKER_03 (25:14):
Because you don't work.
SPEAKER_01 (25:16):
What do you mean I don't work?
SPEAKER_03 (25:18):
You don't contribute.
I don't I contribute.
You don't listen.
SPEAKER_01 (25:22):
Okay, you know what?
If that's the case, then Ireally am not gonna go to work.
SPEAKER_03 (25:27):
Okay, now I work.
All right, listen.
Um action step number two.
This is for everybody.
Listen, y'all need to startbudgeting.
That's what I'm telling y'allright now.
If you know that, for example,for us that we're gonna be more
than$300,$400 every month, youguys got to start considering
that in your calculations ofwhat you're spending on a
monthly basis.
Just keep that in mind, right?
(25:49):
So that you're ready for thesehigher premiums.
Don't forget also, there's gonnabe higher out-of-pocket costs,
also.
So you may want to buff up thoseHSAs, right?
The health spending accounts.
You may want to buff up those umFSAs, the flexible spending
accounts, also, because you'regonna be more of the
responsibility of paying foryour health care is gonna be on
(26:09):
you.
So you might as well just startplanning for that, okay?
Um, so you don't want to walkinto this blindsided, you just,
you know, someone is gonna haveto pay the piper, it's gonna be
you.
So you just want to make sureyou're saved up, right?
One thing that I looked up thatI didn't consider is this if
you're an independent contractorlistening right now, you can
(26:30):
consider a change in yourbusiness structure.
Check this out, right?
You may want to consider abusiness structure that allows
you to purchase coverage througha group plan, right?
So not as an individual, but asa group plan, such as an LLC tax
as an S-corp with at least oneemployee.
So now you're buying a groupplan, and it may just be you,
(26:52):
but the reason why is that theprice spike is really just for
individual plans.
That's what we're finding out.
The price spike doesn't affectgroup plans right now.
SPEAKER_01 (27:01):
So this this is actual, these are healthcare
plans.
SPEAKER_03 (27:06):
Correct.
Correct.
That's just some so but if youchange your structure of your
organization to be like we'regonna cover a group plan, you
might be able to get a betterbenefit.
SPEAKER_01 (27:15):
I see.
SPEAKER_03 (27:16):
Um for the employed physicians, listen, man.
Um if the subsidies expire, justmake sure, you know, there's
gonna be changes in your covereddrugs, there's gonna be premium
increases, there's gonna bedeductible increases.
Um you need to call HR, find outwhat's the scoop.
They can give you a heads up.
Okay.
And then the other thing, thisis, and I think this goes a ways
(27:39):
also, is you know, for those whoare pretty conscious with their
patients, is prepare yourpatients.
Let them know.
Let them know that, hey, um, youknow, whether you are um, you
know, if you have Medicaid orMedicare, depending on if you
deal with those type ofpatients.
Um if you have patients who havetheir own private insurance, or
(28:01):
if you have people who are smallbusiness owners, things are
gonna change and be prepared.
And um, you know, get them readyto be like, hey, listen, like,
you know, there's some optionsout there, you know.
SPEAKER_01 (28:11):
So it's I would say one other thing I would add to
that is that there are nowalternatives popping up.
SPEAKER_03 (28:20):
Oh yeah, you mentioned this.
I f I keep forgetting aboutthis, but yeah, go ahead.
SPEAKER_01 (28:23):
Yeah, there are there are healthcare insurance
alternatives that are startingto pop up.
Um and I don't know we shouldmention one in particular, but
there's um one called Indie Pop.
Um, but it it's like it's kindof like membership-based.
SPEAKER_03 (28:42):
They're not a sponsor, guys.
SPEAKER_01 (28:43):
No, they're not a sponsor.
Um but they're they are kind oflike a membership based.
They, you know, I can't explainthe whole thing um because I,
you know, I don't know all theins and outs, but people are
using it um to essentially notnecessarily purchase ACA plans,
(29:03):
right?
Or have your typical healthcareinsurance.
And people are using it forthings like surgical procedures,
office visits, urgent carevisits.
And apparently there isn't asmuch of the rigmarole of trying
to figure out, you know, am Iauthorized?
You know, do I have to get areferral?
(29:24):
Do I have to do this?
Do I have to do that?
It's much more flexible.
SPEAKER_03 (29:28):
So it's it's it's more like it's more like a
co-op.
SPEAKER_01 (29:30):
Yes.
SPEAKER_03 (29:30):
Right?
So if you depending on whichneighborhood you live in, if you
live in a nice neighborhood,there might be a co-op in your
neighborhood, which is inessence like a supermarket that
everybody contributes to.
The prices are a little bit uhmore expensive, but you get, you
know, the in essence, it's likegoing to Walmart or going to
your local supermarket, but it'sreally more mom and pop.
(29:53):
And the community benefitsbecause you know they have their
own type of supermarket.
SPEAKER_02 (29:58):
Yeah.
SPEAKER_03 (29:58):
As opposed to having a big box company come in.
Now, what you're talking aboutspecifically with with the co-op
is you join a community and thenall the monies that you guys put
in gets rationed out toeverybody within the community.
SPEAKER_02 (30:12):
Right.
SPEAKER_03 (30:13):
And what they end up finding out is that these
co-ops, these communities, spendmoney better than if you went
through an insurance company.
SPEAKER_01 (30:21):
Is that like a healthcare sussu?
SPEAKER_03 (30:24):
Uh for all the immigrants, for all the West
Indians listening.
SPEAKER_01 (30:29):
You not like you know that susu life.
You know that susu life.
SPEAKER_03 (30:34):
Explain what a susu is for those who ain't who ain't
from the Caribbean, please.
SPEAKER_01 (30:38):
So a susu is essentially uh it's kind of like
a savings uh quote unquoteaccount.
It's really not an accountbecause it doesn't go in a bank.
So you get like, let's say, fivefriends, six friends, however
many friends you have, and thenthey all put money into what
they call a susu.
Usually one person is collectingthe susu, right?
(31:01):
And you all take turnsessentially collecting the sussu
such that as everybody collects,then it goes to one person, and
then you rotate the next cycle,then all of the money goes to
the next person, then you rotatethe next cycle.
SPEAKER_03 (31:17):
When an issue happens, right?
SPEAKER_01 (31:19):
When well, it can be when an issue happens, or it can
just be when the cyclecompletes.
SPEAKER_02 (31:24):
Okay, gotcha.
SPEAKER_01 (31:25):
Right.
So after you've done six cycles,everyone should have gotten
money from the sussu.
But sometimes people be takingoff with the susu, you know what
I'm saying?
You gotta be careful about theperson who is like the first,
the third, you know, thewhatever.
If they're not the last personin the sussu, they might just
(31:46):
take off with it.
SPEAKER_03 (31:50):
So do you have any experience with susus then?
SPEAKER_01 (31:52):
No, I've never done a sustainable.
Yeah, me neither.
Specifically for that reason,because people be taking off
with the susu.
SPEAKER_03 (31:57):
Well, I'll I'll I'll preempt it with this.
Do you have you been at a jobwhere they could have been a
susu?
I haven't been at one.
SPEAKER_01 (32:03):
Oh, yeah, I've been at jobs where they could have
been a susu for sure.
SPEAKER_03 (32:06):
For sure.
Yeah, the sports authoritydidn't have one.
SPEAKER_01 (32:11):
But that is a job that could have had a susu.
You think so?
Oh yeah.
Oh yeah.
SPEAKER_03 (32:15):
Well, it depends on who's the demographic, who's the
employees of the like susu ismore of a West Indian type
thing, right?
SPEAKER_01 (32:21):
Like West Indian thing.
Yes, of course.
So But I've definitely I'vedefinitely been at jobs where
there could have been a sussu.
SPEAKER_03 (32:29):
Well, look, uh, we beat this up uh a bit.
So, guys, we're we're gonna goon to our next topic, all right?
So um the next one, the nextthing we're gonna talk about is
a question from a listenerlistener, excuse me, um, who
wants to talk about PSLF andbeing a first generation um
immigrant as well as going intomed school.
We're gonna catch you guys onthat next segment.
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