What Does the Affordable Care Act Have to Do with Pharmacists?

July 11, 2012

By Thomas McAuliffe and Akeiisa Coleman, Missouri Foundation for Health

In late June 2012, the U.S. Supreme Court ruled the Patient Protection and Affordable Care Act (ACA) is constitutional, including the requirement for individuals to have a minimum level of health insurance or pay a penalty beginning in 2014. Having health insurance is tied to better health care access, overall health status and work productivity. As the law is fully implemented, the U.S. will need more doctors, nurses and pharmacists who must work together to achieve cohesive patient care.

What is the ACA? How will the ACA affect me, as an individual?

The ACA will have an impact on many individuals, families and businesses — from where they buy health coverage to what that insurance plan covers. The ACA will expand health care coverage to approximately 32 million Americans including an estimated 510,000 Missourians. Additionally, small businesses and nonprofit organizations could receive almost $40 billion in support to provide coverage to their employees over the next 10 years.

With several overarching goals, the health care law will increase the number of people with health coverage, improve the quality of health coverage and increase wellness and disease prevention efforts. The ACA has been and will continue to be implemented in stages through 2018. Many of its major provisions, like new insurance marketplaces (health exchanges) and the requirement to have insurance coverage take effect in 2014.

In addition to new insurance protections, individuals will see a difference in new health insurance plans, which must include essential benefits. These benefits include: preventive care (e.g., cancer screenings); prescription drugs; hospitalization and emergency services; maternity and newborn care; mental health and substance abuse treatment; and oral and vision care for children. For more information on the Affordable Care Act, or to see a timeline of health care reform implementation dates, visit http://covermissouri.org/docs/Overview.pdf.

How will the ACA affect me, as a pharmacist?

With more than 30 million people expected to gain coverage once the ACA is fully implemented, more health providers will be needed, including pharmacists. A greater number of patients seeing doctors will likely lead to more prescriptions being written and filled.

Pharmacists will be expected to collaborate with doctors, nurses and other health providers to ensure the influx of newly insured individuals receive quality care. With a team-based patient-centered model of care emphasized in the law, health providers have a unique opportunity to improve the health care experience. Pharmacists have been asked to be part of these interdisciplinary teams, as well as participate in accountable care organizations (ACOs), which seek to cut health care costs while increasing care coordination.

The ACA also expands medication therapy management (MTM) programs, which have been found to reduce adverse drug events and improve medication adherence. Additionally, the Medicare Part D coverage gap or “donut hole” will continue to shrink and reduce out-of-pocket costs for patients. As a trusted source of information, pharmacists are likely to get questions about Medicare drug coverage. For more information on Medicare and the Affordable Care Act, see this fact sheet.

How will the ACA affect me, as a small business owner?

The ACA has significant implications for small businesses. A number of measures within the law work to make health insurance more equitable and affordable.

  • Small business tax credits. Under the ACA, small businesses with 25 or fewer full-time employees are eligible for a tax credit covering up to 35 percent of the premiums the business pays. This tax credit, which took effect in March 2010, will increase to 50 percent in 2014.
  • End pre-existing condition exclusions. In 2014, new community rating rules will prevent insurers from charging small businesses more to cover sick workers or from raising rates due to illness.
  • Health insurance exchanges. Beginning in 2014, businesses with up to 100 employees will be able to purchase coverage through an insurance exchange – creating more choices, offering greater bargaining powers, and lowering administrative costs.

You can find more resources on health reform and the latest health coverage news at www.covermissouri.org.

More ACA and pharmacies reading:

–        “The Supreme Court’s health care decision: What does it mean for Missouri?” by Kelsey Proud for KBIA (June 29, 2012)

–         “Supreme Court upholds Affordable Care Act” by Diana Yap for Pharmacist.com (June 28, 2012)

–         “Healthcare Staffing: How Healthcare Reform Will Likely Impact Hiring” by John Rossheim for Monster

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