The hospital, part of the Providence Health system, based in Washington state, has been working aggressively to reduce the number of babies delivered by caesarean section.
The effort — supported by a midwife program, specially equipped birthing rooms for natural deliveries and new protocols to identify obstetricians with high C-section rates — reflects the growing scientific consensus that overuse of C-sections in recent decades exposed mothers and newborns to unnecessary risks, some potentially deadly.
Mission Hospital had another incentive, as well: Covered California in 2016 signaled that hospitals with high elective C-section rates could be excluded from health plans on the marketplace.
"That put everyone on notice," said Dr. David Lagrew, who has helped lead efforts to reduce the number of caesarean deliveries at Providence Health's 10 hospitals in Southern California. "It was a big deal."
Between 2014 and 2018, California reduced its share of caesarean deliveries by 5.5% — faster than all but two other states, according to data from the U.S. Centers for Disease Control and Prevention.
The state has taken other steps to bolster insurance protections, beyond what the federal government mandates.
Covered California, for example, requires health plans to exempt some services from deductibles so patients won't skip needed care. Roughly 1.5 million people get coverage through Covered California, and more than 70% are now in a plan in which primary care visits, lab tests or other outpatient services aren't subject to a deductible.
The state also has begun offering insurance subsidies to middle-income Californians, bolstering federal aid provided by the 2010 law to address the difficulties faced by some consumers who earn too much to quality for federal subsidies.
Some of California's health care improvement initiatives might persist even if the Trump administration succeeds in eliminating the health care law.
Nevertheless, California health care officials warn that preserving protections for people with preexisting medical conditions is considerably more complicated than simply directing health insurers to cover sick patients, as Trump has suggested he would do.