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Bruce Bialosky

Covered California: Masters of Deception

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Bruce Bialosky

I really have not been paying much attention to Obamacare in California. They were pitching how they signed up zillions of people. We have yet to find out whether those enrollees have paid their premiums, are income qualified or are in America legally. But they were proud as peacocks about their results. Then they made an announcement which knocked my socks off.

To quote their website, “The vast majority of Covered California consumers will see low increases in their health insurance premiums for 2015, and many consumers will see no increase or even a decrease. The statewide weighted average came in at 4.2 percent, with some plans offering weighted average rates that are 8.5 percent lower than current pricing.” Wow, that is impressive. How are they getting that done?

Soon after that Florida announced their planned increases for 2015. The Office of Insurance Regulation announced Floridians who buy health insurance on the individual market for 2015 will face an average increase of 13.2 percent in their monthly premiums.

That is a staggering difference. A lot of people like to refer to it as Flor-i-DAH, but that could not explain this difference. And everything costs less there than in California except for cocaine and hookers so it is not a structural difference in costs between the states.

This made me turn to my resident expert on these things – Dr. Jason Fodeman, an adjunct professor at the James Madison Institute. He had an easy answer to this quandary – Covered California has severely limited the network of providers. This was even carried in the Los Angeles Times -(can you believe it?) To quote that column in the Times of September 14, 2013 “To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market. In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That’s less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, There are only 204 primary-care doctors to serve Health Net patients.”

While this speaks of the insurers limiting the access we all know who is calling the shots. To quote a great philosopher (Dick Martin) you can bet your sweet bippy it was the board of Cover California, a group of politicians, who determined the structure and the insurance companies and just dancing to their tune.
What this means for the patients who sign up for this plans is restricted access that will cause them to lose their existing medical relationships like their primary care doctors and specialists. Fodeman stated “This could cause the reordering of lab tests, imaging, transferring of records, extra medical visits which will cause increased costs and no doubt once the law kicks in, costs will ultimately explode in California as well. The plans are basically MediCal lite with the same perverse incentives that MediCal employs which will lead to price controls.”

Fodeman focused on who will be pinned with this disaster—“Once the doctors opt out and the system crumbles, the politicians surely aren’t going to accept blame and no doubt will be coming after ‘greedy’ doctors hard.”

And the doctors are dropping out or not ever beginning to participate. I spoke to Dr. Reed Wilson. Wilson, a Southern California Internist, is the President of a Group called Private Practice Doctors which has 200 members. Wilson told me he had personally spoken to fifty members of the group and one was accepting Covered California.

As usual when you allow politicians to stick their hands in our health care you will not get the straight facts. These politicians know that numbers can say whatever they want and they have done a masterful job of manipulating these numbers. The people who are paying for insurance plans under Covered California will be getting the same kind of doctor access that they are paying for in their taxes for others to get free from MediCal. If they knew that they might not be happy with any premiums they have to pay.