Now Obamacare is Crippling…Family Planning?


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California has very generous funding for family planning clinics, serving people under 200 percent of the federal poverty level. California also has really crappy funding for Medicaid, the federal-state health program for low-income families and children; the state recently cut reimbursement rates to providers and pharmacies by ten percent. That's a bit of a problem, as the Affordable Care Act—Obamacare—pushes more and more people toward Medicaid. In particular, it's a problem for California's family planning clinics, which are expected to start seeking reimbursement from Medicaid instead of from the old Family PACT program.

According to Kaiser Health News:

For the last 15 years, such clinics have been paid through a robust state program called the Family Planning Access Care and Treatment Program, or Family PACT. It is the first and largest program of its kind, covering the cost of family planning services for nearly 2 million uninsured women and men, with no cap on spending. Nearly 60 per cent of Planned Parenthood's income is from the program. But this year, its revenue streams are going to start shifting dramatically: 84 per cent of the clinic's patients became eligible for Medicaid, or Medi-Cal as it is known in California, on Jan. 1, because of the expansion of care for the poor under the federal health care reform.

Quoting Kathy Kneer, the president and CEO of Planned Parenthood Affiliates of California, the article says "clinics will lose money on every Medicaid patient."

Isn't there an old joke about losing money on every sale and making it up in volume? Yeah, it's a bit of a dark joke.

Physicians in general already face this problem. When the latest Med-Cal rate cut was announced, Bloomberg pointed out that a gynecologist in Folsom, California was paid $95 to $200 for pelvic exams by private insurance, but $25 by the state plan even before the ten percent haircut. As a result, just 57 percent of California physicians accepted new Medi-Cal patients in 2011, which was the second-lowest rate after New Jersey. That rate is unlikely to rise with the lower reimbursements, even as 1.1 million Californians were expected to join the Medi-Cal roles as part of the Obamacare grand plan.

California Healthline quoted Jon Roth, CEO of the California Pharmacists' Association, saying, "The margin in drug products is roughly two percent to four percent. If you're looking at a 10 percent reduction, you're immediately upside down and dispensing medication at a loss."

The solution? Many pharmacies say they won't provide medications on which they take a big loss. Pharmacies in other states have flat-out refused Medicaid patients, so this shouldn't come as a surprise.

California's Family PACT program may well have been too generous to begin with—especially in a state with long-term financial difficulties that it's still just papering over. But at least that scheme paid for services rendered. That stands in stark contrast to the Affordable Care Act's promise of expanded services which governments are already unable to afford to an ever-widening pool of recipients who are bound to be disappointed.

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  1. If Sandra Fluke has to pay for her birth control, she is going to be pissed.

    1. If Sandra Fluke has to pay for her birth control,

      it’ll be karma.

    2. She’s not going to need Medi-Cal. She’ll be elected to congress and get some quite sweet benefits.

      1. and her birth control will STILL be paid for by someone else.

        1. Teacher says that every time you jizz inside Sandra Fluke, a bureaucrat gets a job.

          1. That’s one way to cut Leviathan.

            1. It’s progress. And you’re a person who opposes progress if you don’t want to use violence to underwrite the existence of consumer goods and everything else.

    3. She won’t have to pay for it. She’ll just have to wait several months to get her prescription refilled.

  2. OK, I can’t keep up with this newfangled internet generation. Reason posts stories so fast that by the time I read the comments in one (and am ready to supply urbane and witty repartee) you guys are all commenting in the next.

    Maybe I *should* give CNN a try.

    1. Try Lew “get off my lawn” Rockwell oldtimer.

    2. Don’t swet it. I’m right there with you. I’m also an “old timer” and don’t expect to contribute much to the comments. But I read them for my own enjoyment and some good links.

      I guess if we didn’t become a Libertarian in college and we’re old enough to remember Reagan, we’re deligated to the bench.

  3. It’s really quite funny how the ACA took everything that was broken about our system and just straight-up made it worse. How anyone could fail to forsee dumping people on medicaid and then cutting reimbursements would limit access to care?

    1. If only comrade Stalin knew about this!


    2. They knew about it.

      Before implementation my progressive friends were going back and forth as to whether this law was actually an improvement, a clever attempt to crash the system and implement single payer, or a subversion of the political process by moneyed interests (big pharma, insurance companies, etc)

      Nobody really thought it was the first case.

      1. It never occurred to them that by passing it without a single Republican vote they were setting themselves up to get blamed for the resulting failure?

        I am not surprised it didn’t since most Progs are incapable of basic rationality and assume they should rule by divine right.

        1. “It won’t be THAT bad.”

          1. “It won’t be THAT bad.”

            We won’t know whats in the bill until we pass it right? Similarly, we won’t know how to fix the healthcare system until we forcibly ensnare every American into a politically dominated medical regime that will indirectly kill millions of people. Be reasonable you libertines!

        2. It never occurred to them that by passing it without a single Republican vote they were setting themselves up to get blamed for the resulting failure?

          They won’t be blamed. The logical fallacies employed by the Democrats are so readily accepted as the gospel of pure truth, I have doubts that you could ever pin it on them in the public eye, even if they are solely responsible by every rational standard.

          1. If that were true, leftist governments would never have to resort to fixing elections. And they always resort to that.

            1. If that were true, leftist governments would never have to resort to fixing elections. And they always resort to that.

              Do you expect them to suffer through more than one midterm election? They’ll take their heat and their voters will still turn out to vote for the lesser of two evils.

        3. It never occurred to them that by passing it without a single Republican vote they were setting themselves up to get blamed for the resulting failure?

          Obviously the failure is Republicans’ fault. If they hadn’t ben non-team players, this would have been a glorious reformation of the great healthcare system!

          /prog narrative

          1. Obviously the failure is Republicans’ fault. If they hadn’t ben non-team players, this would have been a glorious reformation of the great healthcare system!

            /prog narrative

            By this statement alone, I support your candidacy. Time to clean up Washington and elect somebody who will DO more somethings!

            /Derp Voter

      2. How about sheer incompetence?

    3. I think they do not understand that you can always make something worse. You can also implement a good idea so poorly that it become a bad idea. They don’t get that.

      Combine this with their instinctive belief in government, some crony corruption, and you get the ACA.

  4. As a result, just 57 percent of California physicians accepted new Medi-Cal patients in 2011

    Just a few more laws and we’ll get this all straightened out.

    1. I wonder if laws like the ACA have intentional Easter eggs build into them?

      1. Maybe. Or just invisible ink on the back of the pages. “Haw-Haw! Now doctors are our slaves!”

        Of course, the real way to get at them is through the AMA and licensing. Make low-reimbursement / pro bono work part of the licensed in good standing requirements.

        1. Pro bono means “professional boner,” right?

          1. So pro bono publico is easily understood then.

            Bend over, public, here it comes!


            1. “I will smack that fancy law learnin’ right out of your mouth.”

        2. The intelligent way to deal with this would be to loosen the AMA’s cartel grip on medical licensing. But I agree, the totalitarian approach will be preferred.

        3. I’ve explained this before. Under the 13th Amendment, there’s an exemption from the prohibition against slavery for convicts. Declare the study of medicine to be a capital felony, then enslave doctors for life.

          1. True. Although you could also just declare all convicts to be doctors and let them loose on the poor.

            After all, they said you’d be able to see a doctor–no guarantees of quality were issued.

            1. Whether you get a trained physician depends on whether you have approached your local political officer and have paid him the appropriate respect.

              1. Proper thoughts lead to speedy treatment.

                1. I see you were very mutual last week, comrade. Let’s fix that busted spleen, shall we?

        4. Of course that’s what’s coming. Expect public shaming of.doctors who don’t do medicare/pro bono work in the coming years. The “community organizers” who.cut their teeth on corporate shakedowns for racist and environmental causes will be.itching.to get a taste of all that medical money.

          1. And it will be totally unexpected when the number of doctors leaving the field sky rockets.

            1. That’s easily dealt with by a law, too.

              1. I am sure your new slave doctor will give excellent care.

                1. Look, don’t bring your bourgeois values into this. Doctors who are mutual will provide the best possible care, for the greater good. Personal incentives as motivators are a capitalist myth.

                  1. Unless it is an abortion clinic. Then any regulation of any kind will cause the entire operation to cease.

                    1. In the future doctors will open false “abortion clinics” as.cover.operations for.their.general practices to.avoid smothering regulations.

                    2. I…uh…had my tonsils aborted. Yes, that’s it!

          2. If there’s one group the community activists will break their teeth on, its doctors. You’re hard-pressed to find people who give less of a shit what other people think.

        5. Single payer legal care, with similar requirements for law licenses.

  5. Isn’t there an old joke about losing money on every sale and making it up in volume? Yeah, it’s a bit of a dark joke.


  6. Has there been a single positive effect of this law? Even the people who have “pre existing conditions” are finding out the insurance they can now get is over priced and generally sucks. I have yet to see one concrete statistic or anything beyond anecdotes so vague they border on being urban myths showing anything good coming from this law. It is a free shit law that doesn’t even manage to give anyone any free shit.

    1. Has there been a single positive effect of this law?

      My proggie facebook friends are posting many fewer political things?

    2. But John, that’s what makes it so delicious. It’s the ultimate failure. It fails in everything it said it would do; it even fails to give the necessary free shit to mollify at least some people. It fucks a ton of people, including people who were all for it. It’s beautiful.

      Obamacare is the ultimate expression of modern legislation: pure vanity for the politicians, and pure shitstorm for everyone else. Its implementation is a shitstorm. Its results are a shitstorm.

      As far as these things go, I’d much rather see an epic train wreck like this than something that could just limp along. Train wrecks have immediate consequences.

      1. I agree. This is the first time I have ever seen these people have to live with the consequences of their policies. For fifty years liberal Americans have successfully screwed their fellow citizens without screwing themselves in any immediate and recognizable way. Now there are millions and millions of right thinking liberals who supported this thing seeing their health care and insurance completely go to shit. Delicious is too weak of word to describe the pleasure you get from watching it.

        1. Payback is a bitch.

        2. I blame the kulaks.

      2. But Epi…..now you can be a poet or an artist…and mocking your poor results will be a joy and benefit to us all!

      3. Does the Weather Channel name shitstorms yet?

        1. This would be what “Shitstorm Zeta of the Obama winter”?

          1. Does the Greek.alphabt come after Cyrillic.or Katakana?

            1. Are you on an LG G2? The odd frequency and unnecessary periods in your posts are exactly the same behavior I get from mine.

              1. He’s just flowering into a beautiful young woman.

      4. At least when politicians get us.into a vanity war to pump up their reputations, the destruction happens far away to.people who don’t speak our language, look different than.we.do, and can’t influence.us.politically.

        With Obamacare, the.victims.are here, the economic.destruction is here, and the politicians cannot rely on a willing media to.soft pedal the news from far away–it is.unfolding before.everyone’s.eyes in real time right.here.

    3. Has there been a single positive effect of this law?

      Lots, for cronies, courtiers, and sycophants.

      1. I have yet to seen any concrete examples of even those. I guess maybe the Belorussians who got the website contract made out. But the insurance companies who thought they were getting the law to make everyone buy their product and the excuse to jack up rates don’t seem to be too happy. A few of the especially loathsome hill rats who wrote this have gone on to big K street careers.

        That is a pretty short list.

        1. The insurance companies knew it was an utter failure within the first few weeks. But they’re cool with that, because now they expect to be nationalized into public utilities.

          Their executives are willing do whatever the President tells them to do, whether it breaks laws or violates contracts or kills people or whatever, because they expect to be generously compensated for their cooperation via the infamous “risk corridors”.

          1. I wish them luck with that. Judging by how everyone else has made out on this law, it is a pretty good bet they are going to be woefully disappointed.

      2. That is one of the most delicious things about this law RC. It has destroyed pretty much every one associated with it. Max Bachus’ career is over. Kathleen Sibilius will never hold any elected office or high government position again. Ben Nelson’s career is over. If this thing had not passed, it is doubtful that the Republicans ever take the House meaning there are at least 50 Democrats no longer in the House because of it.

        The only person associated with this who hasn’t seen their career destroyed by it is Obama. He just merely goes on leaving the wrecked lives and careers of his supporters in his wake.

    4. “Has there been a single positive effect of this law?”

      None. Remember, it was ‘comprehensive!’

  7. The hits just keep on comin’

    1. “Did you also go to Hollywood Upstairs Medical School?”

    2. This is why suicide attacks have never been widely used. The good suicide bombers never make it past practice.

  8. OT: I realize this was probably covered in the AM links, but I don’t care. THIS IS HOW WE GET ANTS

    1. This is why suicide attacks have never been widely used. The good suicide bombers never make it past practice.

    2. On that page is a link to a New York Times opinion article about the end of snow.

      I can’t wait.

      1. And water! No more water! It’s all gonna disappear ’cause rethuglicans!

  9. Just another part of the GOP war on women.

    1. The RNC ads practically write themselves.

  10. It should have been fairly obvious that forcing a whole bunch of people to sign up to Medicaid was going to negatively affect anyone already on Medicaid, as well as anyone who had private insurance and was in the wrong income bracket before.

    1. HazelMeade|2.10.14 @ 1:29PM|#
      “It should have been fairly obvious”…

      Yes, yes it should have, but hey, they got the bill passed, right?

  11. Another instance of a state having devised a workable (if not perfect) program which is replaced by a broken, unworkable, and completely unaccountable federal program. Forward!

  12. The Titanic had to collide with the iceberg to see what was under it.

    1. The Trojans had to bring the horse in to find out what was in it.


  14. Unintended consequences are some of my favorite types of consequences.

  15. Family planning? Don’t they have google?

    1. That always confused me, too. Do you want to have kids? No? Then wrap it and take the pill for good measure. Yes? Au natural 3 times a day. Concentrate real hard while doing it and you may be able to influence the eye color. Bam, family planned.

      Why is that so hard?

      1. Condoms reduce the chance of pregnancy by over 95%. When you consider that the chances of a woman getting pregnant from a single act of intercourse is in the single percentages, your chances of getting pregnant by accident are pretty small. You don’t even need the pill, just condoms and a calender. The calender method is pretty unreliable on its own. But if it is combined with condom use, it is pretty close to 100%.

      2. “Family Planning” strikes me as the kind of achingly neutral phrase proponents come.up with.when proposing a controversial idea. It is the “medical marijuana” of the Sexual Revolution.

        1. Despots always hide their nefarious machinations behind innocent sounding words. See ‘Final Solution’, ‘Ethnic Cleansing’, ‘Gun Control’, ‘Affordable Care Act’.

        2. Prevention is a form of planning.

          The worst part of family “planning” is that sooner or later the government will think it’s their job because of the word “planning”.

  16. California also has really crappy funding for Medicaid

    This is actually related to California having very good income limits for Medicaid. Roughly speaking, states get a certain amount of reimbursement money from the feds for Medicaid (based on how much they put in). Some states have narrow income eligibility for people, but pay reimbursement rates close to Medicare, so lots of doctors will take Medicaid. Other states have wide income eligibility requirements, but make up for that and save money by having low reimbursement rates. So more people get insurance*, but good luck finding a doctor who will take it. (* Roughly speaking. The numbers are also based on federal poverty lines, and some states are poorer or richer than others.)

    The Medicaid expansion in the PPACA, because it’s based on income level, was easier for states that already had wide income eligibility (but low reimbursement rates) than the states that had narrow income eligibility but higher reimbursement rates.

  17. Didn’t the California insurance commission base ACA payments off Medi-Cal rates, so lots of doctors will not take Covered California plans?

  18. $95 to $200 for an occasional pelvic exam? Why does insurance need to be involved?

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