State Medi-Cal plans rarely work for patients | Tim Talk | Tim Hunt | PleasantonWeekly.com |

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State Medi-Cal plans rarely work for patients

Uploaded: Jul 27, 2017
While Senate Republicans wrestle to find a way to “repeal and replace” ObamaCare, Covered California officials are assuring the public their system works fine.
The state has enrolled more than 14 million people in MediCal—35 percent of the state’s 39.5 million population. Representations from bureaucrats notwithstanding, the state Dept. of Health was sued earlier this month for “separate and unequal” coverage. A spokesperson denied any issues with MediCal, an assertion that is laughable on its face.
As I have previously written, many physicians refuse to take new MediCal patients because the reimbursement rates are so low. The suit seeks to force the state to raise reimbursement rates and reduce delays in MediCal patients receiving care. That obviously takes more doctors who will accept the state plan. The suit also says that 54 percent of the MediCal population are Latino thus there is a civil rights violation when comparing the state plan with private plans.
Of course, the entire contention is that medical care is a right—a clause that cannot be found in the United States Constitution.
The safety net is emergency rooms because federal law requires anyone needing care be seen in emergency rooms.
And that’s not good news for MediCal. Tracy Seipel reported in the East Bay Times this summer that visits to emergency rooms soared by 44 percent between early 2014 when ObamaCare took effect and late 2016. Naturally, that was opposite of what President Obama assured Americans when he was pushing the Democrat-dominated Congress to adopt his bill. Expanding the federal Medicaid program (Medi-Cal in California) was supposed to lower ER visits because people would be enrolled in managed care plans and would be treated more efficiently and cheaply.
I guess that promise goes along with “you can keep your plan and keep your doctor.”
One person called out in the news story was assigned a doctor for primarily care who refused to see her. So, she used the ER for routine prescription refills, lab work and check-ups.
The state budget that too effect July 1 included additional funds for Medi-Cal reimbursements, but it’s still a minor dent in a huge problem. Rate need to climb to the point where they are comparable with Medicare for enough physicians to see patients and that will substantially dent the state budget that is precariously balanced.
Until this year, Gov. Brown has demonstrated little support for the Medi-Cal patients beyond accepting the federal Medicaid funds. He kept the reimbursement rates very low, while pouring money into k-12 and community college education.
Given that Medicaid costs at the federal level are soaring at an unsustainable rate, you have a fiscal and personal train wreck looming.

Comments

 +   2 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 27, 2017 at 12:35 pm

Scott Hale is a registered user.

actually, the American tax payer is the safety net. That is who pays for the under insured and those with no insurance. So what is the fix?
Single Payer system?
the hoax the GOP is trying (and failing) to pass which will dump 20-30mil more unto the not insured column?
so, the American tax payer can pay for it directly, or pay indirectly. That is the choice.


 +   5 people like this
Posted by Michael Austin, a resident of Pleasanton Meadows,
on Jul 27, 2017 at 5:21 pm

Michael Austin is a registered user.

I believe Obama Care should be repealed.

I also believe government should stay out of citizens life's.
I believe in individual hard work, individually providing for the family and all the families needs.

The liberal mind set, to continuously tax and spend has been out of control for decades. Governments primary responsibility is to protect its citizens.

Government must build a dominant military, close our borders, deport all illegals in America and annihilate terrorist that are a threat to America, where ever they are on this earth.


 +   1 person likes this
Posted by Scott Hale, a resident of San Ramon,
on Jul 27, 2017 at 8:04 pm

Scott Hale is a registered user.

Appeal and replace with what exactly? And what about the millions that will be w/o insurance (not counting those young, healthy, and quite dumb who think they don't need insurance). What do do with those millions?

Like I said: tax payers pay for it one way or another. FACT.

can't repeal until there is a reasonable replacement. Current one less than 12% approval. Are you in that that percent??

BTW, USofA can't simply put boots on the ground wherever we want. Other countries would object and resist. Hello.


 +   23 people like this
Posted by Michael Austin, a resident of Pleasanton Meadows,
on Jul 28, 2017 at 8:09 am

Michael Austin is a registered user.

I am advocating repeal.
I am not advocating replacement.


 +   23 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 28, 2017 at 9:54 am

Scott Hale is a registered user.

Just repeal? By itself. That sounds like this blog: write about problems, provide no possible solutions. You are aware, what 50 million w/out insurance if there is just a straight repeal, roll back? You feel insurance companies will fill the breach? Quite silly opinion, me thinks.

You do know just repeal will never occur. Just like the 'skinny repeal' went down in flames. GOP quite humiliated now. Hopefully congress will learn there are 2 parties and they both need to work together to get something, anything actually done.


 +   4 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Jul 28, 2017 at 10:15 am

DKHSK is a registered user.

Let Obamacare burn. Pin the blame on the Democrats who voted lock, stock, and barrel on this fiasco.

Open up cross-state selling of insurance (something that the states don't really want) and lets see what happens. It can't be any worse than what the democrats have given us.

Meanwhile, medicare continues to cover those who qualified for subsidies under the failure that is Obamacare. They're lost anyway to GDP anyway.

This whole thing reminds me of when California, under Democrat Gray Davis, attempted to open up energy to the "free market". The problem was that it wasn't totally free and ended up being a fiasco that caused blackouts.

Politicians are NOT smart. They know almost nothing about how things work, especially science and business.

Trump is right, let it burn.


 +   9 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 28, 2017 at 12:27 pm

Scott Hale is a registered user.

Only 'problem' with 'let in burn' is how many more Americans will be hurt with either no insurance or totally unable to afford the premiums and/or can't afford the high deductibles or co-pays? What about them?

bottom line the tax payers pay for those w/o insurance or under insured. WE can pay directly or indirectly. Unless hospitals can reject those who can't pay at the door and that will never happen and it shouldn't.

Yes, the current congress is inept, incompetent and very much out-of-touch with reality. And that goes for the GOP controlled and when the DEMs controlled both houses. And then we have the clown President. Where were his self anointed 'master' negotiation skills?

Now on to tax reform where the latest show middle class will pay more to support cuts to the wealthy. Great.


 +   4 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Jul 28, 2017 at 1:21 pm

DKHSK is a registered user.

Scott

It's interesting that I gave an idea yet you hone in on "let it burn" .

I guess when your resolution revolves around "just raise taxes", you run out of any semblance of rational discussion and debate.

What about all the starving people? "Just raise taxes".

I don't have a phone! "Let's raise taxes".

I don't have a car! "Let's raise taxes".

I can go on and on.

Name one modern day government program outside of war that has actually ended any social issue? Poverty? Drugs? Disease?

But let's raise taxes because...?

What a tired argument.


 +   5 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Jul 28, 2017 at 1:24 pm

DKHSK is a registered user.

And blaming this on Trump shows a fundamental lack of civics. You should know better.


 +   11 people like this
Posted by Karl Aitken, a resident of Pleasanton Valley,
on Jul 28, 2017 at 3:38 pm

Scott - Can't agree more with your comments concerning both parties being just as bad as the other and not doing what our country needs.


 +   3 people like this
Posted by Michael Austin, a resident of Pleasanton Meadows,
on Jul 28, 2017 at 5:13 pm

Michael Austin is a registered user.

Scott:
I suspect the "50 million" with out insurance would understand that incentive to get a job!


 +   7 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 29, 2017 at 6:51 am

Scott Hale is a registered user.

actually, Dan, 'let it burn' came from Trump. It's what a 5 year old does when they don't get their way.
dan, really, are you comparing a cell phone to health insurance? You know better than to throw troll comments out. If one does not have a cell phone, the American tax payer will never have to pay for it. Whereas health insurance or lack of, WOULD cause the tax payer to get a hit when said non-insurance holder becomes sick and lands in the emergency room.
As for raising taxes? Not sure I launched that missile. I did say the American tax payers will pay for the non-insured one way or another. With at least ACA is it more indirect paying as insurance companies are mostly, sorta, still in the picture.
I will say that the GOP had 7 years and they produced nothing. A lot of hot air and a lot of stumping of their feet, but no product. Even the American public didn't like (less than 12% approval) the various bills.
Sorry, but your GOP failed. congress, the Prez, Democrats. All of them.
So, GOP will lick their egos and try for tax reform now. Oh boy, great, even more complicated. Maybe now congress will learn to compromise.


 +   3 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 29, 2017 at 6:56 am

Scott Hale is a registered user.

Michael: A bit out of touch? Many Americans DO have job and perhaps their employment is part time or their employer offers no insurance. What about them? A repeal only would have never worked as it would be the worse option all the way around.
You need to view big picture. A sick person with no insurance showing up at the emergency room is paid for via the tax payers one way or another. Unless you are suggesting those with no insurance are refused treatment? Careful, now.


 +   2 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Jul 29, 2017 at 7:28 am

DKHSK is a registered user.

Scott,

"actually, Dan, 'let it burn' came from Trump."

Which is why I wrote "Trump is right, let it burn". Do pay attention.

"are you comparing a cell phone to health insurance?"

No, and its obvious that I'm not. Nice try.

"As for raising taxes? Not sure I launched that missile."

You launched it when you said "so, the American tax payer can pay for it directly, or pay indirectly. That is the choice."

Why is this the "choice"? And exactly why do we have to have a replacement program? Most of the recipients of Obamacare are receiving subsidies. The rest pay increasing rates (yes, this is a tax) every single year its been in existence because someone needs to cover the losses for those on subsidies. Heck, in McCains state alone, rates went up 106% this year!

Don't sit there and blame the Republicans for something the Democrats put in place and failing every metric miserably.

And still you have not one idea accept repeating "the taxpayer has to pay one way or the other".








 +   18 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 29, 2017 at 9:08 am

Scott Hale is a registered user.

Dan: You did compare having a cell phone to health care. Own it. I realize Trump supporters (or his cult) don't like to own things they say. Please do try.

the fact of the matter is the tax payer does pay. One way or another. spin and troll has much as you like. The GOP failed, own that. The entire congress (which, you should know, is both houses) failed. And both controlled by the GOP with a GOP President. Please, own that.

Letting ACA fail, will certainly be worse than attempting to 'fix' it or replace with something the American public can get behind.

so, Dan, tell us how you would fix/repeal/replace. You are a smart guy when you chose to be. Regale us with your ideas.


 +   2 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Jul 29, 2017 at 7:58 pm

DKHSK is a registered user.

Scott,

"so, Dan, tell us how you would fix/repeal/replace."

I already did. Go back and read what I wrote.

"You did compare having a cell phone to health care."

No I didn't. Go back and read what I wrote.

Dan



 +   10 people like this
Posted by Scott Hale, a resident of San Ramon,
on Jul 30, 2017 at 7:17 am

Scott Hale is a registered user.

So, Dan, let it burn is your solution? Figures, since you would not be effected.

Please spend more time you with your replies as it appears you don't track what you write or like Trump, you disengage from reality when tagged. Those silly items you mentioned as sarcasm (missed by the way) do not relate to something like health care, which CAN be life or death. Try to keep up, ok?

Until then please continue to cheer leader the GOP and the wonderful things they have done so far. Control all aspects of government and still do less than before. good job! <sar for those who can't keep up>


 +   2 people like this
Posted by Jake Waters, a resident of Birdland,
on Jul 30, 2017 at 9:26 pm

@DKHSK

I agree with your comments and have been repeating what Trump has said about 'letting it die.' It really is the only smart thing to do, which may wake up somebody among the 535 congressmen/women to provide a better product- unfortunately government is terrrible at running things.

Yes, many millions will lose coverage of this poor product (no one really knows how many, but the number keeps getting higher based on the hysteria), but many millions don't even pay for it, they are inclined to pay the penalty instead due to the expensive premiums. Obama was foolishly counting on the healthy and the young to float this disaster of a Ponzi scheme.

Let's be honest, you really understand the Democrats and Obama, at the time of Obamafraud unveiling, from Jonathan Gruber (key architect) when he was caught stating, “the stupidity of the American voter" made it important for him and Democrats to hide Obamacare's true costs from the public. Either way, we will pay for everyone's healthcare in the end through tax minuplation, back office handshakes, and new bills that will divert funds to the next great healthcare idea.


 +   1 person likes this
Posted by Cholo, a resident of Livermore,
on Aug 1, 2017 at 9:14 am

I agree with Scott that Americans are worthy of healthcare and the USA is in a position to provide that care.

If folks don't like it, then STOP PAYING TAXES.
If you're at the end of your rope, either jump or go back to where your ancestors came from. America doesn't need you...GO BYE BYE.




 +   2 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Aug 1, 2017 at 10:53 am

DKHSK is a registered user.

Jake,

Actually, those already on the subsidy will not lose their coverage because they're on medicare. The rest can buy private plans as they are doing now, they just won't have to go through governmental "exchanges".

The great lie that the democrats keep repeating is that millions will lose their "health care". Again, that is a LIE.

Like you, I'm for letting it burn. Completely.

Open it up to cross-state competition. Why can't I buy a policy from some carrier in Nebraska? Why am I forced to buy from someone in California?

Its a closed market and both the dems and repubs know this and don't want to change it. That's right, I said it: THE DEMOCRATS AND REPUBLICANS DON'T WANT A FREE MARKET IN HEALTHCARE TO EXIST.

They both want a command economy so that we rely on them.

The vast majority of Trump voters voted for him because he promised repeal. Heck, the republican senators and congressman told us they wanted an outright repeal, sent up phony repeal bills knowing that idiot Obama would veto them and then did everything they could to keep what we have.

Primaries are going to be very interesting in 2018 and beyond.


 +   2 people like this
Posted by DKHSK, a resident of Bridle Creek,
on Aug 1, 2017 at 11:05 am

DKHSK is a registered user.

Scott,

"So, Dan, let it burn is your solution? Figures, since you would not be effected. "

Oh yes, I'd be affected, perhaps even a beneficiary of an open market that would reduce my costs. But politicians on both sides of the isle will not let that happen.

The democrats gave us a program that was DESIGNED to fail. This was stated as FACT from one of the main architects of the ACA program, Jonathon Gruber. Look him up.

That you democrats now want us conservatives to fix the mess you created is laughable.

"Until then please continue to cheer leader the GOP and the wonderful things they have done so far."

Had you been paying attention, I've said many times right here on PW that the GOP has been a disaster. Read my missive above to Jake.

You don't have any ideas other than, "gotta pay now or pay later", I get it, but don't call me out for stating the obvious.

Good day.



 +   3 people like this
Posted by seen it, a resident of Birdland,
on Aug 1, 2017 at 2:49 pm

My limited experience with Medi-Cal shows that this system is SO messed up and I can see why it is so expensive.

At one point my daughter finished college and got a new job and because of the timing, Covered California automatically enrolled her in Medi-Cal.

For weeks we received mail, packages, etc from Medi-cal. We could not stop it. Looking at the mail, which was a pile over one foot high, were all this information on medical plans and legalize. So much stuff that there is no way ANYBODY could go through it all and make sense of it. Specifically those in Medi-cal which are typically those in lower paying jobs or unemployed. I own a successful company, have payroll, etc., and I could not figure out all that paperwork. They probably spent $50 alone in postage plus printing. Even if I needed the services, Medi-Cal does not understand their demographic and needs to streamline the paperwork.

Medi-cal was doing everything it could to push you to use Medi-Cal, whether you needed it or not. They obviously want as many enrollees as they can get. This is not a safety-net but rather a way to increase their budget. It took a lot of time to finally get them to remove us from their list. How many others in the same situation?

The current reimbursement from the Feds encourages this mismanagement of funds. When the feds say there is no limit and we will give you more money if you enroll more people, Medi-cal is not concerned on cost, coverage, budgets. They just keep registering as that gives them more money from the feds.

The feds are right to think about removing this unlimited source of funds for this bureaucracy. It is a total mess since they have an unlimited source of funds.


 +   1 person likes this
Posted by Covered, a resident of Amador Estates,
on Aug 2, 2017 at 1:01 pm

Actually the government does provided phones to people who can't afford them. The cell phone companies get a subsidy back to provide phones to the helpless and hopeless.


Sorry, but further commenting on this topic has been closed.

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