The Ohio Republican who oversaw more than 30 votes to repeal, or amend out of existence, the Patient Protection and Affordable Care Act since summer 2010 stopped well short of embracing the health reform law as it currently exists. He did, though, send a strong signal to lawmakers in his party should focus only on revising individual provisions of Obamacare.
One program no one can stop or significantly alter until well after it is well on it's way to full implementation is the establishment of web-based health insurance exchanges for people required to purchase private coverage. The mandate for almost everyone not covered by an employer-sponsored or government plan to buy health insurance takes effect Jan. 1, 2014. To make it possible for people to meet that legal obligation without facing insurmountable barriers, the Affordable Care Act specifies the need for the exchanges.
State or federal officials can design and operate exchanges, but all plans must meet minimal criteria for being listed, including
- No denials based on preexisting conditions
- No yearly or lifetime dollar coverage limits
- No co-payments for prescription birth control
- No co-payment for annual wellness checkups
- Allowing children to stay on parents' plans until the age of 26
- Supporting programs to identify and reduce medical errors and hospital readmissions.
That may shift in the feds' direction after the new year. If a state cannot certify by Jan. 1, 2013, that its exchange will be fully up, running and in compliance with rules issued under the Obamacare law, CMS can step in as the administrator.
This may seem like all so much inside baseball, but pharmacists, pharmacy technicians and student pharmacists should pay close attention to how the health insurance exchanges take shape in the states where they practice. I've written that implementation of Obamacare could bring significant changes for both community pharmacists and health-system pharmacists.
Without qualification I can state that requiring nearly all Americans to carry health insurance, including pharmacy benefits, constitutes the greatest change to how prescription drugs get paid for since Medicare Part D took effect in 2006.
But here's the thing: No one yet knows what plans available through the coming health insurance exchanges will look like. At best, the plans will be the same as any available on the open market. All the PBM relationships will remain unchanged. The only difference would be that more people have coverage.
We should all probably hope that turns out to be the case. But if it does not, the only way not to get caught flat-footed when the calendar turns to 2014 is to stay informed. I'll do what I can to report on developments, and I welcome your questions and suggestions for what to focus on.
Photo courtesy of Schzmo