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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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    Sally MJ | June 2, 2018 at 1:37 am

    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.

    Chicklet | June 2, 2018 at 10:58 am

    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!!!!!

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