After Nancy Pelosi said, “We will have to pass the bill to see what is in it,” a deeply divided Congress pushed through the Patient Protection and Affordable Care Act (PPACA). The nation waited to learn more and find out the answer to the more fundamental questions: What’s in it for me? For my career and livelihood? For the patients I take care of?
For pharmacists, “what’s in the bill” could amount to major changes in the way they do business. They can envision patients lined up at the counter asking questions about their coverage.
Political and ideological opponents are looking for ways to pull back on this massive, costly health care bill, if not to repeal it altogether. Consumers are confused, health care professionals are nervous, and Washington is in turmoil.
By mid-September, some key portions of the bill started to take effect. For example, “young adults” up to 26 years of age can stay or will be added to their parents’ coverage, even if they are married. Coverage for children with preexisting conditions cannot be denied by insurers. Also being phased in now are protection against canceled coverage, no lifetime coverage limits, restrictions on annual coverage limits, and greater consumer appeals rights.
These benefits sound good. Consumer protections, in and of themselves, are valuable and popular. So why isn’t the PPACA more popular? Because those protections aren’t a free lunch. Somebody has to pay for them, and consumers believe it will be them, either in the form of higher taxes, higher premiums, or rationing of care. In fact, we are already seeing insurers take action in anticipation of the coming changes. 3M just announced that they are dropping retiree coverage altogether, citing “fundamental changes” to the health insurance market and “more readily available individual insurance plans in the Medicare marketplace,” according to a memo from the company. The memo went on to note that, “Health care reform has made it more difficult for employers like 3M to provide a plan that will remain competitive.” So much for the narrative that “if you like your current plan, you can keep it.”
To rein in costs while expanding access, ObamaCare will have to do one or more of the following things: ration care, slash reimbursement to physicians, delay the age of entry into Medicare, or improve the efficiency of care delivery across the board. ObamaCare will cut $565 billion from Medicare over the next 10 years. Proponents of the bill will say that those cuts will come from reducing fraud and abuse, reducing waste based on regional variations in care, and standardizing care under comparative effectiveness research. I doubt those savings will be as high as the Administration is suggesting.
As physicians have taken a closer look at the PPACA, many have come out against it, fearing that it will exacerbate both the erosion of the patient–physician relationship and already-declining physician reimbursement. Pharmacists, thus far, have taken more of a wait-and-see approach, which is understandable given that the impact on the profession is a little less obvious. But with an expected shift of power in Congress on the immediate horizon, the opportunity for “replace and repeal” is very real, and it may be here for a short time only. It is incumbent upon pharmacists to take a good hard look at what’s in the bill and come to some conclusions about the impact it will have on them, their careers, and their patients.
Thank you for reading.
The Oncology Care Pharmacist in Health-System Pharmacy
According to the National Cancer Institute, almost 40% of men and women will be given a diagnosis of some form of cancer in their lifetime.
News from the year's biggest meetings
Clinical features with downloadable PDFs