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ACA repeal will usher in period of uncertainty

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After stumbling out of the gate early this month with an ill-conceived  bid to hamstring the Office of Congressional Ethics (a plan that roused a chorus of critics, including President-elect Donald Trump, and was quickly withdrawn), Republicans in the House, along with their colleagues in the Senate, regained their footing and set about the business of repealing and replacing the Affordable Care Act.

ACA enrollment sign upclose_Rite AidHouse Republicans in the newly convened 115th Congress picked up where they left off in previous sessions, during which they voted more than 60 times to undo President Barack Obama’s signature legislative initiative. GOP leaders in the House and Senate are now following a carefully drawn road map for the swift revocation of the ACA.

During a visit to Capitol Hill to strategize with Republican lawmakers, Vice President-elect Mike Pence expressed support for those efforts. He asserted that, in electing Trump and GOP majorities in both houses of Congress, voters registered their dissatisfaction with Obamacare and issued a mandate to put an end to it. Republicans are doing no more than keeping their promise to the American people, he said.

While the incoming Trump administration and its allies in Congress are confident that they have gotten back on track by beginning to dismantle the ACA, their actions have prompted a lot of anxiety and uncertainty in other circles. Democrats, predictably, are up in arms about the looming threat to Obamacare, arguing that repeal of the legislation will force millions of Americans to lose health care coverage and throw the insurance market into turmoil.

In a rare visit to Congress, which occurred at the same time Pence was there, President Obama tried to rally Democrats to convey what’s at stake to their constituents and vigorously defend the ACA.

In reality, though, there is little Democrats can do to stave off the derailment of Obamacare. By including repeal of the ACA in a budget reconciliation bill, Senate Republicans can circumvent any potential filibuster, which under normal procedure would require 60 votes to stop, and enact legislation with a simple majority. Use of the parliamentary maneuver has been criticized by some observers, but it should be remembered that the Democrats resorted to it when Obamacare was enacted.

cdr-filler-opinion-750It seems all but certain that the ACA’s days are numbered, but that’s where clarity ends and ambiguity begins. No one knows what will come next. Trump has made sweeping generalizations, as in this recent Tweet, about developing a health care “plan that really works — much less expensive & FAR BETTER!” Congressional Republicans have been equally short on specifics about what the health care system, which accounts for almost 20% of GDP, will look like after Obamacare, how long the transition from the current system to its successor will take, and how that process will be managed.

All of which puts health care providers, including retail pharmacies, in a difficult position. To begin with, if a large number of people who gained coverage through the ACA lose it, providers will likely see the number of patients they serve shrink considerably. Overturing the legislation will also reopen a number of issues that had been settled, most prominent among them for pharmacies the way in which reimbursements for filling prescriptions under Medicaid are calculated.

The debate over what will replace Obamacare is sure to be as raucous and contentious as the one that preceded enactment of the legislation in 2010. Everything will be up for grabs, and pharmacy advocates will have to be vigilant to ensure the interests of patients are protected and prescription drugs aren’t treated as a commodity in a misguided effort to reduce costs.

Retail pharmacies are well positioned help achieve the goals of creating a health care system that is more accessible, effective and cost efficient. It is incumbent on everyone in the industry to make certain legislators and policy makers in the new administration comprehend pharmacy’s unique capabilities and the potential it has to play a bigger part in keeping people healthy.


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