With Obama’s re-election, ACA implementation proceeds

Pharmacy groups focus on pharmacists’ clinical services; states face tough decisions


After the November 6 elections, pharmacists now know that the Affordable Care Act (ACA) is here to stay. Implementation of the health care reform law on the federal regulatory side is expected to pick up. At the same time, opponents of the law, while unable to repeal it, may try to slow down or block funding for implementation—and states must make decisions on the expansion of coverage promised by the law.

President Barack Obama’s re-election followed the U.S. Supreme Court’s upholding of the landmark law in June, and was coupled with the status quo of Democratic control of the U.S. Senate and Republican control of the U.S. House of Representatives.

“While there will be some activity [on ACA in the Republican-controlled House], I don’t think you’re going to see quite as much action on it as we saw last year and the year before,” said Michael Spira, APhA Senior Lobbyist. “Because that was a run-up to the election. And it’s done. It’s the law.” There could be a battle between the House and Senate on how much is funded and how well parts of ACA are funded, he added.

Another funding issue is that ACA may be a target in this difficult budget environment, with attention in Washington, DC, turning now to deficit reduction with the so-called “fiscal cliff” combination of tax hikes and sequestration cuts.

“During this process [of ACA implementation], APhA is committed to pursuing greater engagement of pharmacists’ clinical services in federal programs, state Medicaid programs, and private plans,” APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, wrote on pharmacist.com’s CEO Blog. He looked to colleague pharmacy groups for a similar focus and willingness to collaborate, and called for the “continued support of pharmacists in all practice settings.”

“States will need to carefully evaluate the opportunities and responsibilities under the ACA and implement them in such a way to ensure the health and well-being of the citizens of their state,” said Rebecca P. Snead, BSPharm, Executive Vice President & CEO, National Alliance of State Pharmacy Associations. “I believe that it will be critical that state pharmacy associations receive the pharmacy profession’s support in working with state agencies to ensure access to pharmacist-provided patient care services.”

Watching the states

Many states took a wait-and-see approach to ACA. Now that the elections have made clear the law will survive, state governments have decisions to make regarding two key parts of ACA’s expansion of coverage. There’s the option to expand Medicaid in their state, following the Supreme Court’s complicated ruling. There’s also the decision on whether to build a state-based health insurance exchange, to partner with the federal government, or to let the federal government run it. In the case of the insurance exchanges, the Obama administration’s deadline for states to submit plans was extended to December 14 (or, for those states partnering with the federal government, to February 15).

After the elections, more state governments continue to be controlled by Republicans than by Democrats. “It is anyone’s guess as to how many states will decide to run their own exchange, but some are predicting that fewer than half of the states will,” Snead told pharmacist.com. “I think there will be a growing number of states that will officially announce that they will be opting out of the Medicaid expansion, as it is viewed by many states as an unfunded mandate.”

Snead added that the number of people enrolled in the Medicaid program is expected to increase regardless of the state’s decision not to expand coverage because people will enroll through the exchanges and learn they qualify for benefits under the Medicaid program.

Key committees in Congress

Regarding pharmacy and specific election results for Congress, there are a lot of changes and a lot of different scenarios.

APhA works with four main committees: on the House side, the Energy & Commerce Committee and the Ways & Means Committee, including both full committees’ health subcommittees; and on the Senate side, the Finance Committee and the Health, Education, Labor, & Pensions Committee. These committees have jurisdiction over health issues important to pharmacy.

With key Members of Congress gone, including Rep. Pete Stark (D-CA), the top Democrat on the Ways & Means health subcommittee; pharmacy-friendly Members of Congress still on the Hill, such as Sen. Jon Tester (D-MT), who was re-elected in a tight race; and new Members of Congress on the way, committee assignments for the 113th Congress have yet to be determined. The underground jockeying for who’s on what committee has likely already begun.