Rx is one key to making ACA work

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WASHINGTON — The importance of pharmacists to the success of the Affordable Care Act was reinforced late last month by National Association of Chain Drug Stores president and chief executive officer Steve Anderson.

“Patients rely on their pharmacies as trusted sources of information on health care topics — even beyond medication issues,” Anderson said after attending a White House meeting on the statute’s rollout. “To live up to patients’ trust and expectations, pharmacies have taken steps throughout the implementation of the Affordable Care Act to help inform patients on subjects including health insurance exchanges — from distributing information to more formal roles in patient education.”

About 29,000 people bought insurance through the federal exchange on the first two days of December — more than the total number that signed up for plans in all of October.

But concerns persisted over the ACA’s launch even as the White House issued assurances the federal exchange website had been largely fixed by a self-imposed December 1 deadline.

Just days before the deadline, the Obama administration said small businesses would have to wait a year to obtain coverage for employees through the federal exchange. The delay resulted in part from the technical problems with HealthCare.gov. White House officials said they had to address the website’s service for individuals before providing online enrollment for small businesses.

The postponement underscores the ACA’s “unmatched complexity” and highlights the administration’s and Congress’ failure to grasp the law’s “negative repercussions,” said National Retail Federation vice president and employee benefits policy counsel Neil Trautwein. “It is hard not to be disappointed that employers and employees will not be able to access care through the ­website.”

“If the law is so burdensome for the administration to implement, think how hard it is for small businesses, which are focused on growing a company, hiring new employees and assisting customers,” he added. “The commercial market is not as forgiving as the world in which regulators operate.”

Insurance companies were among those who questioned whether the upgraded website could meet their needs. In focusing on consumers, insurers said, the White House had left the website unable to supply them all the information they needed to sign up applicants.

“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,’’ said Karen Ignagni, president and CEO of America’s Health Insurance Plans. “In addition to fixing the technical problems with HealthCare.gov, the significant ‘back-end’ issues must also be resolved to ensure that coverage can begin on January 1, 2014.”

Doubts about the website also emerged in the states. Connecticut was considering having its own system to verify insurance applicants’ eligibility for federal tax credits, according to the Wall Street Journal. The state’s chief information officer, James Wadleigh, said he wanted to use state databases without relying on U.S. data, the Journal reported.

Also, five states rejected President Obama’s request to give a one-year reprieve to people whose health plans were canceled because of the ACA. New York, Washington, Massachusetts, Minnesota and Rhode Island said insurers could not reinstate residents’ policies. They took the position that healthy people had to give up existing plans and get new ones on state insurance exchanges to offset the cost of insuring sicker people.

At the same time, states running their own exchanges reported a substantial advance in enrollees. By the middle of last month the 14 state exchanges reported the number of people signing up for coverage had nearly doubled from October, climbing to about 150,000 from 79,000. The nonprofit Commonwealth Fund termed the phenomenon “a November enrollment surge.”

And the Obama administration asserted that the federal website was operating as intended. After a furious five-week effort, Jeff Zients, the adviser leading the repair, said, “The bottom line — HealthCare.gov on December 1 is night and day from where it was on October 1.”

A “progress and performance report” issued by the Department of Health and Human Services said system speed had increased dramatically, with response time running under one second and per page timeouts or failures driven down from over 6% to well under 1%.

Up time was consistently surpassing 90%, and the site supported 50,000 concurrent users spending an average of 20 minutes to 30 minutes on the site. Based on usage trends, it will support more than 800,000 consumer visits per day, the report said.

The president said the website was “working well for the vast majority of users.” He added, “More problems may pop up, as they always do when you’re launching something new. And when they do, we’ll fix those, too. But what we also know is that after just the first month, despite all the problems in the rollout, about half a million people across the country are poised to gain health care coverage through marketplaces and Medicaid beginning on January 1 — some for the very first time.”

“And that number is increasing every day, and it is going to keep growing and growing and growing,” Obama said, “because we know that there are 41 million people out there without health insurance. And we know there are a whole bunch of folks out there who are underinsured or don’t have a good deal. And we know the demand is there, and we know that the product on these marketplaces is good and it provides choice and competition for people that allow them, in some cases for the very first time, to have the security that health insurance can provide.”

As for the pharmacy community’s response to the ACA’s introduction, NACDS’ Anderson noted that pharmacies’ engagement has been similar to their patient outreach and education during the implementation of Medicare Part D.

“The same can be said for pharmacy’s ongoing work to help patients take their medications as prescribed, to foster awareness and accessibility when it comes to flu vaccinations, and to advance other forms of preventive care that have been identified as national priorities,” he said.

Expressing appreciation that community pharmacy was included in the White House meeting, he said “this represents continued progress in raising awareness of community pharmacy’s value as the face of neighborhood health care. Pharmacy’s message is simple and remains consistent: every effort must be taken to present clear and accurate information to patients in a highly accessible and credible manner. Community pharmacy is ideally suited to serve as a highly effective partner when patient care and patient empowerment are the goals.”


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