California's state exchange brings in patients, especially for Kaiser

Thousands of people who bought health insurance through California's individual marketplace are accessing healthcare services at hospitals in the state, according to a report released this week.

House Minority Leader Nancy Pelosi touted the report during a visit Tuesday to the University of California at San Francisco.

The report includes a detailed breakdown (PDF) of the services Covered California patients have received between Jan. 1, 2014, when coverage began, and June 30, 2015. It included data from 111 acute-care hospitals, which represented about 40% of the inpatient care delivered in the state in 2014.

Kaiser Foundation Hospitals, the state's largest health system, saw tens of thousands of Covered California patients at many of its campuses, according to the report. It was one of the largest beneficiaries of the coverage expansion.

At Kaiser's 233-bed medical center in Walnut Creek, for instance, 21,624 people with a Covered California plan accessed inpatient or outpatient services, including 1,102 emergency room visits and 3,724 mental health visits.

At its 414-bed San Diego hospital, as many as 34,168 people with insurance from the Covered California marketplace accessed healthcare services, with 1,590 seeking emergency room care and 5,859 receiving mental health care.

Oakland-based Kaiser, which operates 38 hospitals as well as its own health plan, has rapidly added members, including 524,000 members in the first six months of 2015. However, a recent earnings report did not break out how many of those members enrolled through California's individual marketplace.

At UCSF, Pelosi praised Covered California's “enormous success.”

“Today's report is the latest evidence that the Affordable Care Act is delivering on the promise of making healthcare a right for all, not just a privilege for the few,” she said.

UCSF itself treated 14,305 patients who purchased insurance through Covered California and had 49,689 outpatient visits and 1,218 cancer treatments.

“People insured through Covered California have used their coverage to get care for broken bones, cancer treatment, elective surgeries and life-saving care at some of the best hospitals in our state,” said Peter Lee, Covered California's executive director.

The hospitals included in the report in total delivered 5,745 babies to women enrolled in a Covered California plan, treated 10,928 cases of cancer and saw 65,040 Covered California patients through their emergency departments.

Some hospitals saw smaller numbers of patients with individual plans. San Diego-based Scripps Mercy Hospital, which has 436 beds, treated 256 Covered California patients, and parent system Scripps Health's five campuses saw just under 1,700 patients with coverage from the exchange.

About 1.5 million people are expected to be enrolled in Covered California by the end of the state's fiscal year in June. The marketplace is self-sustaining and funded though fees levied on qualified health plans, according to a state budget report.

However, the vast majority of Californians who gained coverage under the ACA did so through Medi-Cal, the state's Medicaid program, which now has more than 13 million enrollees compared with 7.6 million in mid-2013.

And that has put a strain on many state hospitals, which have collectively pushed for the governor to increase Medicaid rates and roll back recession-era cuts to the program.


Beth Kutscher

Beth Kutscher is based in Mountain View, Calif., and covers healthcare innovation and digital health. Before joining Modern Healthcare in 2012, she was a content editor and healthcare reporter for the New York-based Mergermarket Group. She previously was news and online editor for Pharmaceutical Executive and deputy news editor and healthcare reporter for PRWeek. She has a bachelor's degree in English from Cornell University.

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