Lupin 2023

Uncertainty threatens health care reform rollout

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The run-up to the launch of the centerpiece of the nation’s health care reform plan isn’t going smoothly.

In 44 days people currently without insurance will start to seek information about the new options available to them under the Patient Protection and Affordable Care Act (ACA) of 2010, which was intended to bring 30 million or more individuals into the system and begin to rein in the escalating cost of health care.

Indications are that the weeks and months following the October 1 start of the open enrollment period on the state insurance exchanges will be rocky, with widespread confusion among individuals and health care providers.

Community pharmacies are one of the places people will turn to for guidance in figuring out the ACA. Those companies, which stand to benefit from the substantial expansion in the ranks of the insured, are eager to do whatever they can to make the process work, but they find themselves hamstrung by the absence of meaningful direction from the federal government.

Chain Drug Review recently contacted more than 20 major pharmacy retailers to learn about their plans to help customers understand what the ACA means for them, and with the exception of just four companies — Walgreens, CVS Caremark, Health Mart and Bi-Lo/Winn-Dixie — none were ready to talk publicly about the issue. Even those who did speak out were somewhat guarded in their remarks.

The reasons behind their hesitation stem less from a desire not to tip their hand to competitors than from the lack of adequate information from the government.

A memo sent by the Centers for Medicare and Medicaid Services to health care providers asking them to become a “Champion of Coverage” is surprisingly sketchy. It asks recipients to work with the agency to tout the new marketplaces by utilizing two government websites —, which contains information and promotional material related to the ACA, and, designed to help consumers select a plan or obtain assistance from a government-funded health care navigator.

It goes on to make a number of rather obvious suggestions about how to support the program, including “send an e-mail to your network about the marketplace,” “hang posters and/or give out fact sheets and brochures about the marketplace” and “connect with your partners/members/customers through official marketplace social media channels to share their stories.” (It also notes that training for the health care navigators was not slated to begin until mid-August.)

Such guidance is remarkably inadequate for the biggest change in the health care system since the 1960s, when Medicare and Medicaid were enacted. Advising people about health insurance is a complex task that involves multiple considerations, including the health status of individuals and their financial means. At this stage of the game, detailed information about what role retail pharmacies and other health care providers are permitted to play in the process should be readily available from the government. Until it is, implementation of the program will be in limbo.

That’s a shame, because many Americans need assistance with the ACA. A new survey from CVS Caremark shows that, more than three years after passage of the legislation, 26% of people aren’t aware of it, 36% of respondents likely to enroll on the state insurance exchanges say they need additional information, and just 48% of those who are eligible for a government subsidy think that they are. Much more work clearly needs to be done.

The study’s other major finding, that 68% of respondents expect community pharmacies to provide guidance, either in store or via the Internet, underscores the quandary those retailers find themselves in. They want to do the right thing, but the government has been slow to provide the necessary ­framework.

The problem is symptomatic of the difficulties the ACA has encountered every step of the way. In addition to the fierce political opposition the reform legislation continues to engender, the uniform expansion of Medicaid envisioned by the act won’t happen, with 21 states not planning to go ahead with it and six others still in the process of deciding whether to proceed.

The state insurance exchanges are also a patchwork — 17 states have established them, and the federal government has been asked to co-manage them in 15 others and had to step in and run them in 19 states. One important provision of the ACA, the mandate that companies provide health coverage for their workers, was delayed a year. The situation brings to mind a line from Wallace Stevens: “This is form gulping after formlessness.”

The Obama administration understands how important the next few months will be in determining the fate of the ACA and has geared up to make it a success. One priority should be to give entities in the private sector that are prepared to help the tools they need to reach out to patients.


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