Feb 14, 2010
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Now that the health care bill passed, how do you think that this will affect psychologists? There are many sides to this: job market, pay, insurance coverage for psychologists...
Any ideas out there? This is worrying me... will I have a job when I come out of school? Is it worth it to come out of school, making the "big bucks" (if you are lucky to get that kind of job) only to pay a lot of it in taxes? (there will be new taxes on investments-3.8%, personal insurance plans... basically higher income taxes to punish you for going to school) What are the calculations on that? Will I be able to pay back my student loans at this rate? :eek:

:boom:

Thinking too hard here... I mean, this could change the whole system of therapy in the country! Will we have jobs when this comes into effect?
 

Therapist4Chnge

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I'm hoping that there will be more coverage for neuro testing and overall psych services....because every professional will be giving more back in taxes to pay for millions of people who don't contribute enough.

Let's see how this thread does in here....I'd like to keep it about psychology, but I even feel myself wanting to talk politics...whoops. Okay. On topic......psychology.
 
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As someone looking to enter into school- I am worried about all of the changes made to the higher education funding that was tacked onto the bill... They have the complete bill on NY Times.com, but its a bit difficult to follow. Although I was able to glean definite cuts for "middle class" individuals who are interested in taking unsubsidized federal loans starting in July 2010- that is going to be a problem for me.
 

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I'm curious to see other's responses as well. Considering psychologists don't get paid as much as M.D.s anyway...and if there is going to be a cut in pay for all....:confused: Does seem disheartening considering many are struggling to pay off loans even now!
 

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Actually, I view this as a good thing professionally, as I'm in disability psych, so most of our clients/participants are ineligible for private insurance coverage, creating tons of problems in terms of recruiting (due to federal caps on receiving money for participation)/(and probably) seeing them.

I'm staying out of the political side.
 
Feb 14, 2010
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I was not meaning to start a post on politics, even though I love to debate it. But that is for other forums- here for psychology related questions only... Just to clarify, I was looking to see what professionals in the field now and current students (who all will have a better idea than I do) think about the future of this field. Does anyone have an idea about the future prospects of psychologists/therapists? Research? Will there be less money available to do research? Will therapy be covered under universal insurance? they were talking about cuts from places and I was wondering where they might be (hopefully not psychology!!). Hopefully we can keep this on topic....
 

jnine

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good job staying on topic so far. i'm just gonna button my lip.
 

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I think that extending healthcare coverage to millions of people who didn't have it before can do nothing but help our profession. That's millions of people who now have the option of utilizing our services.
 

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What are these "big bucks" you speak of?? There seems to be a recurrent discussion on here about how little psychologists make compared to other professions and as such, I believe the VAST majority of us will fall squarely in the middle class when we're done with school so I'm guessing we're likely to benefit from the tax cuts rather than face increased taxes.

As for how we will be reimbursed for therapy, that seems much more murky. I for one was not happy with how little of the debate (and possibly how little of the bill, though I haven't read it) dealt with mental health services. I believe that we need much better advocacy in the policy world, 'cause the APA isn't cutting it.

And I don't foresee how the bill will affect research dollars since those are usually separate funding mechanisms all together. The majority of those dollars (NIH, NSF) come from federal science funding as opposed to being tied in any way to insurance. But I guess this remains to be seen.

But like futureapppsy I work with an underprivileged population that often times is uninsured so I think the new legislation will likely benefit me personally.

(Did I manage not to politicize? I hope so :))
 
Feb 24, 2010
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I agree with the sentiment that it will generally be good for Psychologists professionally -potentially 30 more million clients in the pool!

Also, with the changes to the student loans, graduate school will be less financially punishing for those who go unfunded. '
 
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I was taught that a large segment of the private practice's clientele do not use insurance to cover it, since the insurance company requires full disclosure about therapy sessions. So lack of insurance should not be a reason for not getting treatment...
Also, do you think the government will now require full disclosure on our treatment? Will Uncle Sam now require every patient's files to be open to them? Will this make people less likely to get treatment and help?
 

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I agree with the sentiment that it will generally be good for Psychologists professionally -potentially 30 more million clients in the pool!

Also, with the changes to the student loans, graduate school will be less financially punishing for those who go unfunded. '
Really? My impression was that the addendum to the bill would make the interest rates on private student loans go up. This was a consolation because it will save the government money when they no longer subsidize private lenders to give student loans. However, I doubt there will be an appreciable hike in interest rates, as lenders will still seek to offer competitive rates with each other. Also, Obama's other legislation has already eased some of the burden of educational debt, so I think we have an overall net win on that front.

This was from my cursory reading of the legislation. If I am incorrect, please let me know.
 

KillerDiller

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t...
Also, do you think the government will now require full disclosure on our treatment? Will Uncle Sam now require every patient's files to be open to them? Will this make people less likely to get treatment and help?
I don't see why this would happen. Medicaid/medicare do not operate in this manner.
 
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Really? My impression was that the addendum to the bill would make the interest rates on private student loans go up. This was a consolation because it will save the government money when they no longer subsidize private lenders to give student loans. However, I doubt there will be an appreciable hike in interest rates, as lenders will still seek to offer competitive rates with each other. Also, Obama's other legislation has already eased some of the burden of educational debt, so I think we have an overall net win on that front.

This was from my cursory reading of the legislation. If I am incorrect, please let me know.
I meant that the repayment of the loans will be less punishing. From my understanding they reduced the cap of the monthly payment to 10% from 15%, which depending on the size of your loan can be a huge difference.

However, I really don't understand everything in the bill myself. Like you, and I thinke everyone else, we're all trying to get a grasp on what it all will really mean.
 
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I don't see why this would happen. Medicaid/medicare do not operate in this manner.
It was a question, not a statement. I wasn't saying that it would be this way- no one really knows what it really says in the bill, what loopholes might be in there ect- just like in any legislation, passed by either side, only those there know what's going on. I was just saying that if the government will be the insurance provider for most of America, will it now want full disclosure like other insurance companies? Will psychologists be forced to accept the insurance? what will reimbursement rates look like?
Not trying to be political in any way here...I am just scared right now since I am on the verge of entering my graduate school career in psychology. I love this field, but if it will cost much more to go through it than I will make, maybe it is something to think about.
 
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It was a question, not a statement. I wasn't saying that it would be this way- no one really knows what it really says in the bill, what loopholes might be in there ect- just like in any legislation, passed by either side, only those there know what's going on. I was just saying that if the government will be the insurance provider for most of America, will it now want full disclosure like other insurance companies? Will psychologists be forced to accept the insurance? what will reimbursement rates look like?
Not trying to be political in any way here...I am just scared right now since I am on the verge of entering my graduate school career in psychology. I love this field, but if it will cost much more to go through it than I will make, maybe it is something to think about.
From my understanding the government aren't the insurance providers. It's not a single payer system...yet. That was one of my hang ups was that there was no public option. From understanding, everyone has to buy private insurance. If you can't afford it, you will have government assistance in getting private insurance.
 

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Here are some of the positives from the bill.

------------------------------
FACTBOX-US healthcare bill would provide immediate benefits

Fri Mar 19, 2010 6:46pm EDT

WASHINGTON, March 19 (Reuters) - The U.S. House of Representatives is heading for a Sunday vote on a sweeping overhaul of the $2.5 trillion U.S. healthcare system.

House Democrats are confident they can overcome solid Republican opposition and pass the bill. Leaders are using a two-step process where the House approves Senate-passed legislation and then votes for a separate package of changes to satisfy concerns of House Democrats. The Senate is expected to approve those changes as well and President Barack Obama plans to sign the bill into law.

Here is what to expect if the bill becomes law:

WITHIN THE FIRST YEAR OF ENACTMENT
*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.
*Insurers will be barred from excluding children for coverage because of pre-existing conditions.
*Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.
*Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.
*A tax credit becomes available for some small businesses to help provide coverage for workers.
*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011
*Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
*A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
*Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
*Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
*An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012
*Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
*An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
*The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013
*A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
*The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
*The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
*A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014
*State health insurance exchanges for small businesses and individuals open.
*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
*Health plans no longer can exclude people from coverage due to pre-existing conditions.
*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.
*Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015
*Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.
WHAT HAPPENS IN 2018
*An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions. (Reporting by Donna Smith; Editing by David Alexander and Eric Beech)

SOURCE: http://www.reuters.com/article/idUSN1914020220100319
------------------------------

Obviously it ignore ALL of the cost issues, inflation issues, access to care issues, side benefits at the state-level, and it only uses nebulous terminology for reimbursement levels for providers.....but it isn't all bad.
 

AcronymAllergy

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As I (most likely incompletely) understand it, the bill itself doesn't mention psychology/psychologists, or even mental health, much at all. It'll affect us in the way that states and medicare/medicaid handle the changes, as those changes will trickle down to us.

The sentiment at the moment, from what I've gathered, seems to be a significant increase in patient population (due to the influx of new medicaid patients) with a decrease (not sure how substantial) in compensation.
 
Feb 14, 2010
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can you clarify this? What issues specifically are you refers to... in particular, I'm wondering about the inflation, access to care issues, and side benefits at the state-level. Thanks.
I dont want to get too political but I will try to give technical details about certain things mentioned.
Inflation- the value of money decreases as more money is printed. This is normal to happen at some amount, all the time. The value of a penny today is not what it was 75 years ago. Today people throw them aside and dont pay much attention to it. Then, a penny could pay for a lot- food. People are paid a lot more today, since the value of a dollar is less. (FYI-rise in inflation means the dollar is worth less). Bottom line, when the bill says that prices will be set at 2010 prices, it doesnt take into account that dollar amounts are really different.

Cost- the cost of producing something (materials, labor, time ect) is not taken into account. Costs are different than prices. Prices are set by the company but costs are inborn. You cant demand that the prices will be less than the cost or no one will make the item.

Access to care issues- there are only so many doctors and specialists out there. If everyone will have equal access to the doctors, there will be some sort of line to get into the office. Who wont get care? last person on line who might be the most in need? Oldest? one most likely to not survive? I am not sure if this is what T4C meant...
 

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Really? Also, Obama's other legislation has already eased some of the burden of educational debt, so I think we have an overall net win on that front.
Which other Obama legislation are you speaking of? I would love a link because my understanding of pre-existing legislations was that government programs and legislation only apply to Federal loans or loans that can be consolidated into a Federal direct loan, which the large majority of Private loans cannot be, so in reality not much help at all?

I would be curious which legislation you are talking about
 

AlaskanJustin

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Which other Obama legislation are you speaking of? I would love a link because my understanding of pre-existing legislations was that government programs and legislation only apply to Federal loans or loans that can be consolidated into a Federal direct loan, which the large majority of Private loans cannot be, so in reality not much help at all?

I would be curious which legislation you are talking about
Ok I found some answers here http://thechoice.blogs.nytimes.com/2010/03/22/loan-q-a/

But basically what I was afraid of is right, 1) this reform only applies to loans taken after the effective date, which appears to not be until 2014.

Also, loan forgiveness etc as discussed here http://www.finaid.org/loans/dl-vs-ffel.phtml is only available for the Direct Loan program.

I think more answers will come out pertaining to this and other health care issues (relative to psychological practice) will come out with time.

J
 

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I'm DEFINITELY staying out of the political side, but I read that behavioral health will be covered.
 

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Ok I found some answers here http://thechoice.blogs.nytimes.com/2010/03/22/loan-q-a/

But basically what I was afraid of is right, 1) this reform only applies to loans taken after the effective date, which appears to not be until 2014.

Also, loan forgiveness etc as discussed here http://www.finaid.org/loans/dl-vs-ffel.phtml is only available for the Direct Loan program.

I think more answers will come out pertaining to this and other health care issues (relative to psychological practice) will come out with time.

J
Yes, I was referring to the assistance given out for the Direct Loan program. I assumed that people who take out private loans to pay for education are also maxing out the government loan options and will thus benefit from having that part of their debt forgiven.
 

KillerDiller

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It was a question, not a statement. I wasn't saying that it would be this way- no one really knows what it really says in the bill, what loopholes might be in there ect- just like in any legislation, passed by either side, only those there know what's going on. I was just saying that if the government will be the insurance provider for most of America, will it now want full disclosure like other insurance companies? Will psychologists be forced to accept the insurance? what will reimbursement rates look like?
I understood you were asking a question. What I didn't understand is why you would think that would be the case. I'd never heard anything of the sort.
 
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I'm DEFINITELY staying out of the political side, but I read that behavioral health will be covered.
Would you be able to provide some source for this? Because while I personally believe that mental health is important (and can be vital for physical health), many out there don't share the same ideas and will say that's the first to cut. If they had a choice between physical care and mental, many would choose physical. So, basically I am wondering where you read that cuz I haven't heard anything about that (and have read a lot on it) but would love to be better informed, especially now that Obama signed it into effect...
Thanks.
 

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Glad to see this thread hasn't turned into a political free-for-all!

I didn't see too many details on specifics, but here is an article showing APA support for the recent health care bill:

http://www.medicalnewstoday.com/articles/183179.php

The end of the article states
"Goodheart (APA president) noted that the legislation includes significant provisions related to integrated health care, mental health and substance use benefits at parity with medical/surgical benefits, prevention and wellness, workforce development, health disparities, comparative effectiveness research and long-term services and supports."




As I (most likely incompletely) understand it, the bill itself doesn't mention psychology/psychologists, or even mental health, much at all. It'll affect us in the way that states and medicare/medicaid handle the changes, as those changes will trickle down to us.

The sentiment at the moment, from what I've gathered, seems to be a significant increase in patient population (due to the influx of new medicaid patients) with a decrease (not sure how substantial) in compensation.
 
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Glad to see this thread hasn't turned into a political free-for-all!

I didn't see too many details on specifics, but here is an article showing APA support for the recent health care bill:

http://www.medicalnewstoday.com/articles/183179.php

The end of the article states
"Goodheart (APA president) noted that the legislation includes significant provisions related to integrated health care, mental health and substance use benefits at parity with medical/surgical benefits, prevention and wellness, workforce development, health disparities, comparative effectiveness research and long-term services and supports."
This is interesting (I read the article) but I do not see how or why the APA said this... As you said, there aren't too many details and specifics. If you could find out more on this it would be interesting, enlightening and might have an impact on our careers! Thanks for sharing
 

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Doesn't the recent (2008) mental health parity legislation mean that the majority of newly created insurance plans will have to cover mental health needs up to the same dollar amount that they allocate for medical and surgical procedures? I think this act would still be applicable unless the recent legislation actually contained a clause that repealed this.
 

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also as part of the health care bill was a big overhaul of the federal student loan problem. not sure how this will play out for graduate students but i'll be interested in seeing what happens:

http://www.nytimes.com/2010/03/26/us/politics/26loans.html?ref=us
I remember reading yesterday that Senate Republicans had successfully challenged two components of the Health Care "fixes" bill that related to student loans/lending. Anyone know what those two components addressed?
 

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I remember reading yesterday that Senate Republicans had successfully challenged two components of the Health Care "fixes" bill that related to student loans/lending. Anyone know what those two components addressed?
I may be mistaken (and a lot of the politics of this whole thing are hard to follow) but I believe that when they say that they succesfully challenged them, they just mean that they forced them to be voted on a second time (primarily as a delaying tactic). They didn't actually get them removed.
 

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I may be mistaken (and a lot of the politics of this whole thing are hard to follow) but I believe that when they say that they succesfully challenged them, they just mean that they forced them to be voted on a second time (primarily as a delaying tactic). They didn't actually get them removed.
Yeah, I remember them successfully forcing a vote, but I thought I'd read that because the Democrats didn't have the necessary 60 members to win said vote, they'd ended up losing two aspects of the student loan portion of the bill.

Then again, I could be confusing myself, and the 60-vote necessity might've just been to stop the two challenges from going through.
 
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Obscure structural protests by GOPers led to a second vote. This was approved and the bill is now final.

The final bill does include removal of the multi-billion dollar subsidy to the for-profit loan industry (and also includes Sallie Mae). Up until now, private lenders accounted for about half of student loans (through the FFEL program). The government provided a large subsidy to private lenders (what amounts to about 6 billion annually).

Now, the government will be directly providing student loans to students, cutting out the middleman (and saving 6 billion annually, plus government will now receive profits from the interest rates instead of the for-profit lenders. The government had provided about half of loans, now they will provide all loans.

The government plans (in the bill) are to use half the savings to expand the Pell Grant program (raising pell grants by about $450 annually per awardee, and also raising the number of pell grants awarded). About 1/6 is earmarked for deficit reduction. The remainder of the savings are not, to my knowledge, discussed in the bill. For a brief overview on the student loan revamping that was passed as part of health care reform, go here:

http://money.cnn.com/2010/03/25/news/economy/student_loans_senate/index.htm




Yeah, I remember them successfully forcing a vote, but I thought I'd read that because the Democrats didn't have the necessary 60 members to win said vote, they'd ended up losing two aspects of the student loan portion of the bill.

Then again, I could be confusing myself, and the 60-vote necessity might've just been to stop the two challenges from going through.
 

AcronymAllergy

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Obscure structural protests by GOPers led to a second vote. This was approved and the bill is now final.

The final bill does include removal of the multi-billion dollar subsidy to the for-profit loan industry (and also includes Sallie Mae). Up until now, private lenders accounted for about half of student loans (through the FFEL program). The government provided a large subsidy to private lenders (what amounts to about 6 billion annually).

Now, the government will be directly providing student loans to students, cutting out the middleman (and saving 6 billion annually, plus government will now receive profits from the interest rates instead of the for-profit lenders. The government had provided about half of loans, now they will provide all loans.

The government plans (in the bill) are to use half the savings to expand the Pell Grant program (raising pell grants by about $450 annually per awardee, and also raising the number of pell grants awarded). About 1/6 is earmarked for deficit reduction. The remainder of the savings are not, to my knowledge, discussed in the bill. For a brief overview on the student loan revamping that was passed as part of health care reform, go here:

http://money.cnn.com/2010/03/25/news/economy/student_loans_senate/index.htm

Thanks for clearing that all up.