Children With Severe Medical Conditions Denied Treatment by Obamacare Plans

National   |   Burke Balch, JD & Jennifer Popik, JD   |   Feb 6, 2014   |   2:32PM   |   Washington, DC

Two new reports highlight the growing evidence that, thanks to Obamacare, the quality of many Americans’ current healthcare is gradually declining. New Obamacare exchange plans are going to be more restrictive, with less access to doctors and healthcare centers with specialized expertise and high reputations for providing effective life-saving medical treatment. Not only are those with private insurance feeling the sting, but in addition those in Medicaid programs (primarily for the poor) are finding it increasingly difficult to find doctors who will see them.

In yet another story detailing private health care’s decline under the Obama Health Care exchange plans, Seattle news station King 5 aired a segment on January 20, 2014, describing how children “are being denied specialty treatment by insurance providers on the Washington Health Benefits Network.”

wait-time-survey-merrit-hawkins-500According to the transcript of the television report:

Administrators at Seattle Children’s today said they predicted this would happen, and it’s even worse than they expected — Patients being denied specialty treatment at the hospital by insurance providers on the Washington health benefits exchange. Children’s filed request on behalf of 125 of their patients. Of those, they say they got only 20 responses, eight of which were denials.

Dr. Sandy Melzer says all this comes after reassurances of certain unique specialty cases would still be covered: “Well, some of the patients who were denied are ones who clearly would fall into that unique category. A two-year-old with new significant neck mass that was being evaluated for infection or malignancy, an older child with a chronic severe medical condition requiring multidisciplinary care here, a baby that had a skull abnormality.” Children’s went ahead and treated those cases anyway, but Dr. Melzer said they can’t afford to keep doing that it way.

While many are quick to blame insurers, the real culprit is the Obamacare provision under which health insurance exchange bureaucrats are excluding insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders.

sickchildUnder the Federal health law, state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount.

(See documentation at

This evidently is creating a “chilling effect,” deterring insurers who hope to be able to compete within the exchanges from offering any adequately funded plans that do not drastically limit access to care.

When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.

More on declining coverage can be found at

Another way the Obama Health Care law intends to cover more Americans is by expanding the number of those covered by Medicaid to include those with higher income levels. But new evidence of rationing is emerging in Medicaid programs.

Kaiser Health News reported on a survey of physicians on January 29, 2014, in a piece by Jenny Gold entitled, “To Schedule A Doc Visit, Get In Line.”

The bad news is that fewer doctors are accepting Medicaid: An average of 45.7 percent of physicians surveyed take Medicaid coverage, down from 55.4 percent in 2009. Acceptance rates varied widely, however, ranging from 73 percent in Boston to 23 percent in Dallas. An average of 76 percent of physicians surveyed accept Medicare.

The rates of Medicaid acceptance are likely to prove problematic as more and more Americans sign up for Medicaid under the Affordable Care Act. “At the end of the day, it doesn’t matter how many physicians you have,” says Singleton. “If no one will take your insurance, you’re going to end in the same place, and that’s probably the ER.” And with more patients covered both by Medicaid and private insurance, he says, wait times are likely to get worse.

The problem is that those with private insurance have long been, in effect, subsidizing care for the poor. Doctors have been reimbursed far less than the value of their services when they see Medicaid patients. They used to be able to afford to do so because they saw many people with more generous private insurance.

Medicaid makes up a huge portion of state budgets and is often extremely difficult to fund adequately. The shortfall is putting a squeeze on government payments that are falling farther and farther behind medical inflation.

And with the one source of funding that doctors had been relying on (those with generous private insurance) diminishing with the new Obama exchange plans fewer and fewer doctors can afford to take on new Medicaid patients.

While Obamacare continues to roll out in 2014, it is important to continue to educate friends and neighbors about the dangers the law poses in restricting what Americans can spend to save their own lives and the lives of their families.

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LifeNews Note: Burke Balch, JD & Jennifer Popik, JD write for National Right to Life.