More than three years after it was signed into law and just over six months before its major provisions take effect, the Patient Protection and Affordable Care Act (ACA) is as controversial as ever.

Patient Protection and Affordable Care Act, ACA, Jeffrey Woldt, Medicaid coverage, health care reform, health insurance, community pharmacies, Department of Health and Human Services, HHS, Kathleen Sebelius, Kantar Media, Enroll America, pharmacy operators, Medicare Part D, pharmacist

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Inside This Issue - Opinion

How retail pharmacy should approach the ACA

June 17th, 2013

More than three years after it was signed into law and just over six months before its major provisions take effect, the Patient Protection and Affordable Care Act (ACA) is as controversial as ever.

The governors of 15 states oppose expanding Medicaid coverage — a key provision of the legislation, but one the Supreme Court, in the only major reversal the ACA has suffered, ruled states could opt out of — and six others are still deciding on a course of action. The Republican-controlled House of Representatives continues to try to roll back the measure, voting, at last count, on 37 different occasions for its repeal, despite the fact that the chances of convincing the Senate, where the Democrats are in the majority, and President Obama to reverse course on health care reform are nil.

Confronted with that ongoing battle, many opponents have turned their attention to implementation of the ACA, creating a tricky situation for community pharmacies and other health care providers. Getting accurate information into the hands of the millions of Americans who will gain access to insurance coverage for the first time as a result of the legislation, many of whom polls show are uninformed about the changes in the works, is critical if the reform program is to achieve its objectives. The Obama administration understands that and is mustering forces for a major communications offensive.

That effort is led by the Department of Health and Human Services (HHS), which has already spent $46 million on advertising that touches on the ACA, according to a recent report by Kantar Media. With enrollment set to begin in October, much remains to be done, and HHS is assembling its own resources as well as cooperating with Enroll America, a nonprofit group led by former members of the Obama administration that is attempting to get people to buy into health care reform.

Critics of the ACA blasted HHS Secretary Kathleen Sebelius earlier this month when she told a House committee that she had recommended to three organizations — Ascension Health, Johnson & Johnson and Kaiser Permanente — that they support Enroll America. Republicans asserted that such contacts were improper, if not illegal, on the part of the head of an agency with regulatory authority over health care companies.

ACA opponents have also questioned HHS’ plans to field a large group of so-called patient navigators to help those entering the health insurance system sort through the options available to them. Skeptics are concerned about the level of screening and training the navigators will receive, and whether they will function as rivals to insurance brokers in the private sector.

What should pharmacy operators do in the midst of such a contentious environment, one in which opinion surveys indicate the public, as well as elected officials, remains fairly evenly divided about the wisdom of health care reform? The answer is to be guided by what’s best for the patient. In this instance, it’s clear that an individual with adequate insurance is in a much better position to stay healthy than one who lacks it. Pharmacy chains should, therefore, be prepared to help the people who come into their stores gain a thorough understanding of what the ACA means for them and find the right coverage for their particular needs.

With a combination of access and trust that is unmatched by other health care providers, community pharmacists will be the first place many patients turn for assistance in maneuvering their way through the reform process, and the profession is certainly up to the task. During the rollout of Medicare Part D, which provides prescription drug coverage to senior citizens, pharmacists distinguished themselves as a pivotal resource by performing the role of confidant and advisor.

The pharmacy sector’s contributions at the time won the notice of government officials and did much to raise the industry’s standing. Implementation of the ACA is another opportunity for community pharmacy to demonstrate that it is ideally positioned to interact with patients to help bring about improvements in health care delivery.