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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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    Mac45 | June 1, 2018 at 1:04 pm

    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.

    pst314 | June 1, 2018 at 1:23 pm

    “…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.

    pwaldoch | June 1, 2018 at 1:58 pm

    “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…

        Andy in reply to Henry Hawkins. | June 1, 2018 at 11:38 pm

        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.)

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