The ACA (Affordable Care Act) is a complex set of laws intended to reform the US Healthcare system, which passed in 2010. Its goal was to expand coverage to all Americans and help reduce healthcare costs in general. Earlier this year (2014), the Health Insurance Mandate clause went into effect. Under this mandate, all Americans are required to have health insurance. Individuals who do not will pay a tax penalty, which will increase on an annual basis. The media is full of controversies of whether the ACA will be successful or not. The glitches in enrolling in an insurance exchange were well discussed.
While many debate whether the ACA will truly reduce healthcare costs, I have seen many patients burdened by it. While it is getting un-insured people medical coverage, I believe others are actually being harmed by the ACA.
How Are Patients Being Harmed By The ACA?
1. Many are being force to purchase health insurance coverage that they may not actually want to buy. While the economy struggles, many people are living pay check to pay check. Putting the added mandatory burden of another expense on their already stressed budgets is causing undue stress and anxiety. They are having to make cuts in things they used to consider essential for their well-being.
2. Under the new insurance exchanges, most patients are required to pay large deductibles. I have seen many patients have to make a decision or whether or not to see me for an acute problem because they are unsure if they will be able to afford the deductible. More patients are sticking it out with infectious illnesses to avoid the deductible due to their financial situation. This is making it more likely that they will suffer harmful consequences if it were to be a serious illness, and they are putting others at risk by spreading the infection rather than getting treated.
3. Patients are putting off coming for follow ups of their chronic medical problems for the same reason. Patients with chronic disease such as diabetes, hypertension, renal disease, etc, need regular consistent follow up to prevent complications from developing. Many patients are skipping these visits.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
4. Prescription medications are increasingly not covered due to formulary changes. While this has been a problem for many years, recently when patients change plans under the insurance exchange, they find the medications they have been on for long periods of time no longer covered. I have seen asthmatics come in wheezing because they were not able to afford their inhalers at the pharmacy. Sure, we can change to a different covered medication. But, patients should not have to get to the point that they can’t breathe to make that change. I have seen this with many patients with many different medications.
5. Many patients now need to pay a deductible for their medications. Many are deciding which ones they can afford and which ones they will forego. Most often, this decision is just made based on cost. Rarely, is it decided by the necessity of a given medication.
While great expectations were placed on the ACA, we have seen it fraught with many problems. In my own practice, I am seeing the stress and potential harm that it is causing my patients. While controlling costs and getting all Americans covered with health insurance is a grand ideal, doing it in a way that harms or stresses those people is not the way to do it. It then becomes a burdensome mandate rather than a true solution to a very real healthcare problem.
