December 10 2013
Patrice J. Lee
The phrase “If you like your…” has become emblematic of President Obama’s broken promises regarding ObamaCare. It is so familiar that you could probably complete the title just from those first few words.
We’re now learning we can add medications to the growing list of medical plans, services, caregivers and care providers Americans currently enjoy but may kiss goodbye soon thanks to ObamaCare.
Health insurance providers are looking for ways to reduce the costs of the drugs they provide because of rising costs, so medications covered in the past may no longer be covered. Also, patients will face higher out of pocket costs for the drugs that they are able to get.
The President famously promised that you could keep your health plan and doctor. For many people, both of those pledges are turning out to be false. And now, you might not be able to keep your medicine, either.
There are two reasons why. The first has to do with the higher out of pocket costs patients will face. The second issue may be even more significant.
Simply put, many drugs may not be covered at all, and the costs patients incur by buying them with cash won’t count against out of pocket caps. This has repercussions for drug makers with big portfolios of specialty and primary care drugs (more on that later). But most of all, it has implications for patients.
Obamacare is a throwback to the old HMO model of the 1990s, which promised a broad package of coverage for primary care benefits like vaccines, and routine doctor visits. But to pay for these benefits, the Obamacare plans skimp on other things – principally the number of doctors you’ll have access to, and also, the number of costlier branded drugs that make it onto formularies.
Many Americans rejected these restrictive HMO model plans in the 1990s, in favor of PPO-style plans that had higher cost sharing for routine health services, but offered broader access to doctors and have bigger drug formularies. What Obamacare says, in effect, is that Americans made the wrong choice when they rejected those HMO plans in favor of PPOs. The President thinks the more comprehensive, but restrictive HMOs were the better choice after all.
What can Americans do if their drugs aren’t covered? The Center for Medicare and Medicaid Services says they can appeal to seek coverage, but as the column points out:
But this appeals process can take months. And there is no sure chance of winning.
If a drug costs tens of thousands of dollars a year, how many patients will be able to foot that bill out of pocket until they win an appeal, or take the chance that they could lose the appeal, and be stuck with the full cost of the drug?”
The biggest problem in all of this is that consumers will have a very hard time figuring out where they stand. In many cases, the health plans being offered in the Obamacare exchanges don’t make information about their drug formularies readily available. In some cases, it doesn’t seem to be published anywhere.
This bodes well for patients doesn’t it? This is the “reform” we needed.
The President and healthcare reform advocates created an effective story about the brokenness of our healthcare system as evidenced by the rising healthcare costs. Even more, they scared voters into thinking that if nothing was done the U.S. economy would fall off a cliff. Yet, the fact that entitlement spending –Social Security, Medicare and Medicaid– accounts for 44 percent of federal spending was left unsaid.
The President’s collectivist philosophy begins with the assumption that Americans are not smart enough to make logical and healthy decisions for themselves. The President’s philosophy is behind legislation like his sweeping healthcare “reform” bill and Nanny State bans. Apparently, we need the guidance of experts who have book knowledge at best and little real world experience. Their ideas are meant to save us from ourselves.
Contrary to this philosophy, Americans have demonstrated that they know what’s best for them. In a free society with a market system that rewards businesses which respond to signals from consumers, inefficiency and ineffectiveness get the boot. Innovation drives new ways of doing business and competition generates new goods and services that are valued by consumers.
The Forbes columnist highlights that the healthcare system developed PPO insurance plans in response to Americans’ rejection of HMOs. The President wants to resurrect a system we’ve already said we don’t want.
This is all part of the failed experiment that is progressivism. Each day’s revelation of what is in ObamaCare, exposes this philosophy as patronizing of our intelligence. It kills innovation and stamps out freedom.