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Covered California strong-arms hospitals into cutting services

Covered California strong-arms hospitals into cutting services

Is this the rationing we were promised wouldn’t happen?

The Obama administration once touted Covered California as a wonderful example of state health insurance exchanged.

However, in the wake of more freedoms offered to Americans under President Trump (e.g., the end of the individual mandate), it turns out many Californians are opting out of forced purchase of health insurance.  This is especially true as premiums are set to soar.

According to an analysis by the Insure the Uninsured Project (ITUP), enrollment drops in exchange based plans managed by Covered California could result in as many as 1.2 million more uninsured Californians in 2019.

The Covered California budget announced last week, projects an increase in premiums of an estimated 9-13 percent due to a combination of federal policy changes and related enrollment declines.

The administrators of Covered California are now scrambling to reduce costs. Therefore, hospitals are being strong-armed into reducing services in a blatant cost-cutting measure.

Starting in less than two years, if the hospitals haven’t met targets for safety and quality, they’ll risk being excluded from the “in-network” designation of health plans sold on the state’s insurance exchange.

“We’re saying ‘time’s up,'” said Dr. Lance Lang, the chief medical officer for Covered California. “We’ve told health plans that by the end of 2019 we want networks to only include hospitals that have achieved that target.”

Here’s how hospitals will be measured: They must perform fewer unnecessary cesarean sections, prescribe fewer opioids and cut back on the use of imaging (X-rays, MRIs and CT scans) to diagnose and treat back pain. Research has shown these are problem areas in many hospitals — the procedures and pills have an important place, but have been overused to the point of causing patient harm, health care analysts said.

The excuse that is being used is that too many C-sections are performed.

Many women who don’t need a C-section often get one anyway, according to the data — and it varies from hospital to hospital. Even for low-risk cases, Lang says, several California hospitals are delivering 40 percent of babies by C-section. At one hospital, it’s 78 percent.

…Hospitals get paid more to perform a C-section than a vaginal delivery, and the operation usually takes less time, though it is major surgery. Performing it when it’s not needed exposes a woman to unnecessary risks: infection, hemorrhage, even death.

Color me skeptical about the motives. Furthermore, in a race to meet the targets, there is real possibility that a necessary C-section would not be performed, and that could prove fatal to both the mother and child. The decision should be between the patient and doctor, not by a bureaucrat checking statistics.

I would argue that this is the first phase of health care rationing that conservative activists warned would happen.

Covered California also made another move that hints at their financial troubles: It is now marketing strongly to college graduates.

Many are going to have to suffer through an Obamacare promotion during their graduation ceremonies.

Graduation season is in full bloom and Covered California is joining with commencement speakers throughout the state to remind the over 400,000 graduates and their families not to forget about the importance of health insurance during this busy time of year.

…Among those who have agreed to participate are commencement speakers at California State University – Los Angeles, the University of California at Irvine and the University of California at Merced have agreed to carry the message to graduates in their speeches.

Strong-arming hospitals. Strong-arming college graduates. If Obamacare were really working as promised, none of these tactics would be necessary.


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Making room for the law that will cover illegal immigrant’s health coverage. All as planned.

I can just see it now…hospitals with top notch service for the better off and then hospitals for the less well off with minimum bare bone services. What is needed? More Mexicans sneaking in expecting free care.

The “promise” mentioned in the sub-head was made by liberals.

Liberals lie.

Humphrey's Executor | June 1, 2018 at 9:50 am

Rationing is inevitable. Everything is rationed. We all set limits on what we will or will not pay for. The ultimate question is: Who decides?

    notamemberofanyorganizedpolicital in reply to Humphrey's Executor. | June 1, 2018 at 10:33 am

    CA Death Panels decide.

    “Rationing is inevitable. Everything is rationed.” Those are two patently untruthful statements. While I can agree that in some circumstances an item or service may inevitably be subject to rationing, “everything” is obviously untrue.

    Unless, of course, you are supplying your own definition of the word. It appears that is the case as you are citing people making decisions on those things for which they wish to pay, and those which they make the determination they do not wish to pay. Given the composition, it is obvious you are presenting that as example of rationing.

      PODKen in reply to Edward. | June 1, 2018 at 6:49 pm

      Products and services are not infinite. They are controlled by those that provide them. Who gets them is determined by price. Price is the means of rationing.

The elderly will get the ax soonest, the people who will make the decisions on health coverage will see they are closer to death, so they are a drain on the system, requiring higher cost care and they don’t likely contribute as much as the young in taxes. Medications will be cut to reduce costs, and the illegals will be treated well as the Democrats want their votes.

Out of pocket will be high for those who are older, this so they can discourage them getting operations.

Politicians will call it compassionate care, and the leftists will lap it up and spew the propaganda about how much they care.

    5under3 in reply to oldgoat36. | June 1, 2018 at 10:21 am

    At the 20 week ultrasound the doctors could see that for one of my children that his spine was not fully developing. He has Caudal Regression Syndrome and I’d say we’ve already easily passed $1 million in medical costs. He is only 14 and facing another major surgery. Lucky for him he wasn’t born in Sparta or a new modern version of Sparta where he would not be born.

      Arminius in reply to 5under3. | June 1, 2018 at 10:36 am

      My only son was born with hydrocephaly. He only lived a few minutes. And in those few minutes he stole my heart forever. I am so glad your child has survived this long.

        Arminius in reply to Arminius. | June 1, 2018 at 10:37 am

        Is that a bad way to put it?

        Anonamom in reply to Arminius. | June 2, 2018 at 10:14 am

        Every human life has value. I am so sorry for your loss, Arminius.

        I lost two babies to miscarriage. I so look forward to meeting them in Heaven, to seeing them in their perfect state. I hope it brings you comfort knowing that your precious son is waiting for you.

      Anonamom in reply to 5under3. | June 2, 2018 at 10:21 am

      He’s blessed to have parents who value him and advocate for him, 5under3. Blood tests during my pregnancy showed that my daughter was at high risk for Down Syndrome and multiple ultrasounds showed biometric indicators, as well. It was gross how frequently medical personnel wanted to talk abortion. (And she does not have Down Syndrome, BTW.)

For those who remember the proposed HillaryCare (circa 1994), mammograms were barred for women before age 50.

The obamaCare medical review board has/had the same regulatory power, only difference was the barring of the pre 50 mammograms was intended to be in the statute.

California really does seem to be hopelessly lost in a special kind of stupid.

Medical Darwinism …..

The decision reference point will be the worth of the person to the collective. Just waiting for “completion of existance” rules to be finalized.

Baby Alfie is the poster child for the New California.

Democrats were for unnecessary c-sections before they were against them. John Edwards made millions by convincing juries that cerebral palsy was caused by the doctor not performing a c-section.

An abortion is between a woman and her doctor, everything else is subject to government oversight.

    Daiwa in reply to Anchovy. | June 1, 2018 at 2:40 pm

    Twelve thumbs up if I could.

    JohnSmith100 in reply to Anchovy. | June 2, 2018 at 7:30 pm

    I agree, and I think that Republicans have lost lots of voters as a result allowing radical religious people to try to impose their beliefs on others. Assuming it is not a welfare queen having babies to get a check, life and death decisions should be solely made by immediate family. Where welfare queens are concerned, state aid should require a mandatory implantable birth control. Only one mistake per citizen should be tolerated. While on state aid parents should be forced to actually parent well, or lose the child.

Third party paying always leads to increased charges for services. Always. This because businesses exist to make money and will maximize profits by charging all that the market will bear. The skyrocketing cost of healthcare, not healthcare insurance, is why governments are taking over the healthcare insurance market. People HAVE to have a third party payer in order to afford healthcare services. However, in order to be able to afford to pay for healthcare services, healthcare payers have to reduce the cost of the services. This requires either price controls or rationing. So, no surprise here.

    Shane in reply to Mac45. | June 1, 2018 at 2:36 pm

    And the reason they have a third party payer is because of wage caps many moons ago. Now we have an untaxed monetary benefit through the third party.

    When can we get rid of the government’s hand?

      Mac45 in reply to Shane. | June 1, 2018 at 9:58 pm

      Wages have nothing to do with this. Medical costs were rising post WWII because consumers had more money and could afford more medical care. However, in the mid 1960s every thing changed. The largest third party medical cost payer in the world was developed, Medicare. Medicaid soon followed. Now, it was no longer necessary for medical providers to depend upon the ability of consumers to pay for their services. The government was going to do that. To make it worse, the government, as with private insurers, set its level of payment at a percentage of the cost charged. This merely encouraged medical service providers to increase their charges even more to reap the largest amount of reimbursement that they could. It got the point, by 2000, that the average American could not afford to pay for his medical bills, directly. He had to have insurance. But, medical costs continued to increase to the point where consumers could not afford the medical care insurance premiums necessary for the medical insurance company to make a profit. And, that is where we are today.

“…cut back on the use of imaging (X-rays, MRIs and CT scans) to diagnose and treat back pain.”

When I had acute lower back pain, I was told that the cause might be something else, including abdominal problems of various sorts. And if it really is back pain, can doctors reliably determine its cause without imaging? Muscle strain vs. slipped or deteriorated disks?
Comments solicited from readers with more medical knowledge than me.

“and cut back on the use of imaging (X-rays, MRIs and CT scans) to diagnose and treat back pain.”

So how do they plan on diagnosing back pain? They need to rule out/or discover bad spinal disks and other than a crystal ball how are they gonna ‘see’ what the spine area looks like?
This is coming from someone who’s wife spent 15 years in back pain until a good doc look at an MRI (a previous doc’s MRI at that) and said, you have no disk between these vertebrae. No amount of stretching and exercises will fix this.

assemblerhead | June 1, 2018 at 2:08 pm

None of these bureaucrats remembers why C-Sections became the norm.

I was born before C-Sections became available. The doc used forceps to ‘pull me’. He crushed my skull into my brain. Can you say ‘prenatal brain damage’?

People older than me remember all the people with ‘deformed’ skulls, retardation, and other mental problems that resulted from ‘pulling a baby’.

What is extremely stupid …
the insurance companies forced the use of the ‘C-Section’ by refusing to pay for the ‘pulls’ and resulting liabilities.

Even a rancher knows … when you pull a calve, never tie the rope around its neck!

    I thought C-sections became the norm because lawyers like John Edwards were very successful in claiming cerebral palsy was caused by distress to the baby during birth.

      assemblerhead in reply to Xmas. | June 2, 2018 at 9:38 am

      Treat this statement as unconfirmed :
      Cerebral palsy claims were, to my understanding, responsible for NO anesthesia being used on the infant. Even during / after corrective surgery on the infants deformed skull.

      I have a permanent headache.
      ( maladaptation to pain )
      Registers on the Pain Scale around 4.
      Why? NO anesthesia was used.

      No anesthesia effects the headache.
      Not even sodium pentathol.

and as for the rest of the country- we are still stuck with Obamacare and not a peep is happening.

Just left my day job- and cobra is more than the mortgage on my house back when Obama was running for office.

Finding that all the Obama plans are garbage, we are going with Medishare.

    Henry Hawkins in reply to Andy. | June 1, 2018 at 5:30 pm

    I have to pay big bucks for adequate non-Obamacare insurance, but just for grins, last November I applied for Obamacare just to see what I’d get. The best plan was $670/month premium for a $15,000 deductible plan. It’s identical to catastrophic plans made illegal in 2011. I’m 62 and I’ve never hit $15,000 in one year. Assuming my good health continues, this plan would have provided me exactly nothing, all for just $670 a month.

      Which is exactly why I didn’t bother signing up for the Obamacare fraud. At 61, I haven’t even seen a doctor in almost thirty years. My “medical” expenses amount to bottles of Ibuprofen and boxes of bandaids – an estimated $100 over the last three decades.

      Knock wood…

      It looks like I can get myself and my family in for under 400/month w/10k deductible.

      Anonamom in reply to Henry Hawkins. | June 2, 2018 at 10:30 am

      “It’s identical to catastrophic plans made illegal in 2011.”

      This. This is the part that makes me insane. Cheap catastrophic plans were supposedly evil and bad and wrong, so Obamacare instituted them across the board and slapped a zillion dollar price tag on them. Yay?

      We went with a healthshare ministry 2 or 3 years ago when our former Blue Cross plan hit $2600 a month and the Obamacare alternative was $1400 a month WITH A $13,000 DEDUCTIBLE. It’s insane. Our solidly middle to upper middle class family cannot afford health insurance, but by gosh we can afford to pay for non-working losers to have it. Grr. (And, for the record, I have no objection to aid being given to those who truly cannot provide for themselves. But I’ve seen the system in action; those who actually cannot provide for themselves are few and far between.)

Ironically, the excellent hospitals will not be in the network. And Covered California will have a hard time selling the network without the great hospitals. What will be left in the plan are what we in healthcare refer to as the “dog and cat“ hospitals. It’s a game of chicken. They need the good hospitals. And they will relax their criteria – after barking a hell of a lot. They always do.

There’s a nationwide campaign out there to reduce elective caesarean sections. Many young women want the baby born on Friday, so they can be home on Monday. They want the kid to come out on the day the grandparents have arrived from Iowa to see the new child, or the doctor will do a few today because he’s planned a cruise to Greece 6 months ago. These births are extremely expensive; for example, New York State reduces payment for an elective C-Section by 75% to a hospital that lets this nonsense go on. I’m OK with that.

The other stuff is an unintended (or intended) consequence of allowing all those illegals to get California insurance (paid with state funds, because federal funds supposedly can’t be used). A desperate “Dual” patient (Medicare and Medicaid) wants back pain pills, those narcotics help them through the weekend without having to use their own money on street drugs.

Docs, under enormous pressure not to prescribe opioids (even though opioid deaths simply aren’t happening in the patient group who got them for known, chronic diseases under a doctors treatment), will order some X-Rays or an MRI so they can find some little thing wrong to get the drug-addled patient out of the building with what they wanted (free Medicaid covered drugs) and get proof they’re not a pill-pusher.

This nonsense happens all day long, not just in California, but in all states where care in the ‘government programs’ market is controlled by dozens of government bureaucracies, managing a budget instead of people. When you make stuff ‘free’ demand for it goes up- the good bureaucrats in Cali are apparently just finding this out. They want to punish doctors and patients for the government’s stupidity, as always. If you live in a blue state, you’re next. Sigh…..

Guy: Doc…I accidentally cut my arm off with a chain saw!!!!

Doctor: OMG….nurse, band-aid….Stat!!!!!