Flawed ACA launch doesn’t change Rx’s mission

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The halting performance of the federal health insurance exchange during its first weeks of operation dealt a harsh blow to everyone with a stake in the success of the Affordable Care Act.

The Obama administration looked less than competent in the implementation of its signature domestic initiative; the uninsured and other Americans who turned to HealthCare.gov to explore their options were frustrated, if not frozen out altogether, by myriad computer glitches; and community pharmacies and other health care providers eager to help their patients understand what the ACA means for them were confronted with an unwelcome hurdle.

Further doubts about health care reform resulted when some people satisfied with their current coverage received notification from insurers that the plans would be terminated. Critics of the ACA were quick to point out that the practice contradicts the promise repeatedly made by President Obama that Americans would be able to keep policies they liked after enactment of the legislation.

Obama defended the ACA during an appearance late last month at Faneuil Hall in Boston. While admitting mistakes in the development and operation of healthcare.gov (whose debut Secretary of Health and Human Services Kathleen Sebelius told a House committee was a “debacle”), the president asserted that the ACA is already delivering tangible benefits to consumers and will ultimately meet the objectives of improving access, enhancing outcomes and reducing costs.

He said the legislation has created “a true Patient’s Bill of Rights” — which prevents insurance companies from engaging in such practices as charging higher premiums to individuals with health problems and imposing lifetime or annual limits on coverage, and requires most plans to cover mammograms and other screenings for free — and established a marketplace that will help contain costs.

The setting for Obama’s speech was carefully chosen. Seven years ago then Massachusetts Governor Mitt Romney (who went on to become the Republican candidate for president in 2012) signed the state’s ground-breaking health care reform legislation at Faneuil Hall. Current Governor Deval Patrick, a Democrat who embraced what came to be known as Romneycare, appeared with Obama. His remarks about Massachusetts’ experience help put the flawed rollout of the ACA in perspective. He recalled that the launch of the state’s program was also hampered by technical problems and enrollment got off to a slow start. With patience and persistence, those problems were overcome, Patrick said, and today the program is seen as a resounding success.

“Virtually every resident in the commonwealth is insured today,” he noted. “More private companies offer insurance to their employees than ever before. Over 90% of our residents have a primary care physician. Preventive care is up and health disparities are down. Most important of all, on a whole range of measures, we are healthier both physically and mentally.

“Over all these years, expansion itself has added only about 1% of state spending to our budget. And, thanks to the collective, continued hard work of this coalition, premiums are finally easing up. Premium base rates were increasing over 16% just a few years ago. Today, increases average less than 2%.”

In many important respects, Obamacare looks a lot like Romneycare and could, if the administration shores up its efforts at implementation, eventually deliver similar results.

Whatever its ultimate impact, the ACA is the law of the land and will go forward, at least as long as Obama is in the White House and Democrats control the U.S. Senate.

Despite the continued controversy and political wrangling over health care reform, pharmacy operators should prepare for an influx of newly insured patients, a group that over time is expected to include some 30 million individuals.

With the growing shortage of primary care physicians, first-time customers, along with existing patrons, are likely to see community pharmacy as a place to do more than get a prescription filled. Members of the profession should do whatever it takes to position their stores to capitalize on the ongoing revolution in health care.


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