HEALTH

Decoding Health Reform 2.0

BY Rob Eder

As I write this column, it’s the final Super Tuesday primaries in eight states, including here in New York, before the big mid-term elections in November. And if the Sunday morning news shows are right, the Democrats are in for a spanking. Given the present state of the economy, the stagnant job market and the American electorate’s need to find someone to blame, it’s really kind of inevitable.

Certainly, health reform hasn’t proven to be the societal glue keeping the country together that many in Washington had hoped it might be. More and more the polls indicate that Americans are unsure of what ObamaCare really means for them—whether it means less or more for people who already have health care. An August Kaiser Health survey found that 43% of Americans still had a favorable view of the health-reform act; 45% had an unfavorable view.

I have been fairly certain that the Patient Protection and Affordable Care Act of 2010 would morph and evolve into something quite different from its present form long before we have reached the official implementation date in 2014. While HHS, CMS, the GAO and every other fancy acronym that interprets the laws Congress writes and the President signs figures out how to take the massive piece of legislation from words to action over the next few years, the shift in power this November will feed something I have called Health Reform 2.0.

To be sure, it will be called something else, something MUCH longer by the time it becomes law. And while I can’t predict everything the new version will contain, I am certain it will favor the use of more private sector-driven solutions—like retail clinics.

The introduction of a Senate resolution in late July designating the first week of August as National Convenient Care Clinic Week is a good sign that the ladies and gentlemen on the Hill are aware of the important role clinics will play in the future.

I also believe that Health Reform 2.0 will reintroduce eligibility for tax deductions for over-the-counter purchases under flexible spending accounts. Why? Because eliminating OTC eligibility from FSA plans stands in diametric opposition to the overarching spirit of health reform.

Under the old rules, depending upon what tax bracket you were in, you could save anywhere from 15% to 20% on every healthcare dollar spent by allocating a certain amount of pre-tax dollars to an FSA each year—including most OTC remedies. Under ObamaCare, OTC eligibility has been scrubbed from FSA plans to help pay for the total cost of the plan.

But eliminating OTC eligibility from FSA plans will drive up total out-of-pocket costs for millions of Americans who have come to rely on the exemption to make health care more affordable. According to the Bureau of Labor Statistics, as of March 2007, 33% of American workers who worked for companies with 10 or more employees participated in FSA programs.

This is precisely the kind of thing Americans don’t like about ObamaCare. But it is a relatively easy thing to undo.

In 2003, the Republicans took the Clinton White House’s vision for universal health care and turned it into the Medicare Modernization Act of 2003, creating the Part D drug benefit. It isn’t perfect, but it is an example of a market-based solution that has helped make the cost of healthcare more manageable for the average senior.

Maybe that’s the new definition of bipartisanship: the Democrats made health reform an issue; now it’s up to the Republicans to figure out how to pay for it.

Either way, I believe Health Reform 2.0 will favor more private-sector solutions that incentivize consumers to make smarter, more cost-efficient healthcare purchasing decisions that save real dollars for patients and payers. Kind of the way it worked when you could use tax-free dollars to pay for your OTC purchases if you were on an FSA plan.

keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon's entry would shake up the most?
HEALTH

Dr. Siegal’s Cookie Diet introduces CalciOs

BY Allison Cerra

VIENNA, Va. Dr. Siegal’s Cookie Diet has expanded its offerings to include calcium-fortified cookies designed to treat occasional heartburn.

CalciOs cookies are vanilla-flavored cookies, each one providing 30% of the daily value of dietary calcium, Dr. Siegal’s Cookie Diet said. The cookies contain calcium carbonate, designed to treat heartburn relief. CalciOs also are free of artificial colors and preservatives.

keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon's entry would shake up the most?
HEALTH

Pharmacies should get out of tobacco-selling, into smoking-cessation game

BY Antoinette Alexander

WHAT IT MEANS AND WHY IT’S IMPORTANT The news that San Francisco’s board of supervisors gave preliminary approval to ban tobacco sales at all retailers that operate pharmacies, including mass merchants and grocers, is a step in the right direction, because if drug stores are going to be banned from selling them, then all retail pharmacy outlets should be banned. However, there’s an even bigger picture to consider.

(THE NEWS: Report: San Francisco supervisors OK tobacco sales ban at pharmacies. For the full story, click here)

As many dollars as pharmacy retailers made selling cigarettes, there is much more to be gained in medication therapy management, and there is a significant opportunity for retail pharmacy to have a greater stake in the future of health care.

Cigarette smoking has been identified as the most important source of preventable disease, illness and death worldwide, according to the American Lung Association. Smoking-related diseases claim an estimated 443,000 American lives each year, including those affected indirectly by "secondhand" smoke.

Furthermore, smoking-related healthcare expenditures are a major drain on the U.S. healthcare system. According to the Centers for Disease Control and Prevention, smoking cost the United States more than $193 billion in 2004, including $97 billion in lost productivity and $96 billion in direct healthcare expenditures, or an average of $4,260 per adult smoker.

Clearly, there’s a positive role that pharmacists can play in smoking cessation. To further support this, a recently published study on the "effect of a pharmacist-managed smoking-cessation clinic on quit rates" found that pharmacists can play a vital role in smoking cessation, especially in a group setting, as they can reach more people within the same time frame.

The study found that at three months and six months, 47.6% and 52.4% of patients reported being smoke-free, respectively. The study was conducted on patients that had participated in the pharmacist-managed Smoking Cessation Group Clinic at the University of Iowa Hospitals and Clinics. Participants received structured group counseling on various topics associated with cessation.

It also should be noted that in August, the Centers for Medicare and Medicaid Services announced that Medicare coverage for seniors trying to quit smoking was expanded to include everyone on Medicare.

keyboard_arrow_downCOMMENTS

Leave a Reply

No comments found

TRENDING STORIES

Polls

Which area of the industry do you think Amazon's entry would shake up the most?