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Recent events illustrate the high stakes involved in getting health care right.
At the center of the 16-day federal government shutdown and threat of national default, which were only ended by a last-minute deal reached shortly before the Treasury Department’s authorization to borrow money was set to expire, were demands by House Republicans that the Affordable Care Act be delayed or defunded.
The confrontation that ensued took a heavy toll on both political parties, especially the GOP, and the economy. Standard & Poor’s estimates that the closure of nonessential parts of the government reduced spending by $24 billion and will cut GDP in the fourth quarter by more than half a percentage point.
The fact that House Republicans would risk so much over a fight they should have known they could not win, as long as the Senate was controlled by Democrats and President Obama was in the White House, reflects the deep concerns many people still have about the ACA’s impact. Conservatives are unhappy about the mandates for individuals and businesses, and predict that the law will hamper economic growth and swell the federal budget deficit.
Proponents of the ACA, Obama’s signature domestic achievement, counter that prior to passage of the legislation the country’s health care spending was growing at an unsustainable level, even as more than 40 million people went without coverage. They assert that something had to be done to limit costs, improve access and enhance care.
Implementation of health care reform has had a troubled beginning.
When the open enrollment period started on October 1, technical problems on healthcare.gov, the Web portal for those seeking information about the new insurance options, caused it to malfunction, frustrating many would-be enrollees. Before the start of the month, community pharmacy executives also expressed concern that they hadn’t been given adequate guidance by the Department of Health and Human Services on how to counsel customers who turn to them for insights about insurance coverage under the ACA.
Despite the inauspicious debut, health care reform — which the Centers for Medicare and Medicaid Services projects will cut the number of uninsured individuals by 30 million by 2022 — will go forward. But that won’t end the debate.
The problem of rising costs persists. CMS estimates that health care spending will grow 5.8% during the decade that started in 2012, a full percentage point faster than GDP. If those expectations pan out, health care spending will account for 19.9% of GDP by 2022.
It’s evident that further policy adjustments will be required, although it’s questionable whether the federal government, at least in it’s current configuration, will be up to the task.
Retail pharmacy is in a surprisingly good position to weather the political volatility and cope with the health care challenges that need urgent attention. Already widely acknowledged as the most accessible health care providers, pharmacies are expanding their scope of practice to make their stores community health centers.
The transformation is exemplified by the migration of flu shots and other vaccinations to the retail setting. A innovation not all that many years ago, getting an immunization at a pharmacy, usually on a walk-in basis, is now the norm for many consumers.
Further changes are afoot. Intensive medication therapy management programs, screenings for such conditions as diabetes and hypertension, and preventive health services are increasingly common. The often stated goal is to get pharmacists to the point where they are practicing at the top of their license.
That evolution received a significant vote of confidence earlier this month when California Gov. Jerry Brown signed a bill recognizing pharmacists as health care providers. The legislation authorizes such professionals to go well beyond dispensing medications.
“Whenever pharmacists are allowed to provide additional health care services, patients win,” says Edith Rosato, chief executive officer of the Academy of Managed Care Pharmacy. “Outcomes are better, and they’re more satisfied with their care. The system overall benefits too — through lower costs, fewer drug-related adverse events and better access to care.”
In addition, the health care provider designation strengthens the hand of pharmacists as they strive to change how they are reimbursed. A long-term goal of the profession is to move the reimbursement model away from a focus on products dispensed toward an emphasis on services rendered. It also should help reinforce their status as an integral part of the health care delivery team.
The evolution of retail pharmacy is part of the bigger realignment in health care delivery that’s well under way, a process supported by but not dependent on the ACA. Regardless of what transpires in Washington in the future, pharmacy operators are committed to adapt their practice model to address the growing need for efficient, effective health care.
