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The illogic of ObamaCare

In most families, moms are the caregivers, and most moms have a medicine “box” or tray with all kinds of cures for middle-of-the-night pains and fevers. If it’s not in the “box,” a quick trip to a local 24-hour pharmacy usually secures the needed treatment. When that doesn’t work, a doctor’s visit secures a prescription to be filled at the local pharmacy.

But for most situations a caring mom, Mother Nature and over-the-counter medications get children well and avoid unnecessary physician visits and expenses.

Under ObamaCare, much of that is about to change.

For years, consumers have been encouraged to use lower cost generics and less expensive and easily available over-the-counter medications.

In the past five years, more than 20 million Americans have purchased account-based health insurance (Health Savings Accounts and Health Reimbursement Arrangements). Available since 1978, millions more use Flexible Spending Accounts.

Many use a plan-provided debit card to pay for insurance-qualified medications, including over-the-counter medications such as prenatal vitamins, antacid, allergy medicines, pain relievers and cold medicines.

Under the Patient Protection and Affordable Care Act, however (Section 9003), “A drug is a prescribed drug determined without regard to whether such drug is available without a prescription.”

Translation from government-speak: Effective Jan. 1, 2011, an over-the-counter (OTC) medication must be prescribed by a doctor to be defined as a qualified medical expense – even if it is otherwise available without a prescription.

Only in the world of government control and bureaucracy would it make sense for a mom, treating a sick child at 3 a.m., to need to get a prescription for an over-the-counter medication.

In the government world of economics, it was estimated the new provision for OTC medications would save more than $5 billion. Why? They assumed that parents will pay cash and not get it covered by insurance reimbursable under tax-advantaged accounts such as Health Savings Accounts, Health Reimbursement Accounts or Flexible Savings Accounts.

Here’s what is likely to happen in the real world:

1. Moms, pharmacists, the family doctor, and the child will be mystified. They won’t understand the need for a “prescription for non-prescription medications.”

2. Despite the inconvenience, moms will need to take children to the doctor’s office to get a prescription for the OTC medication.

3. Doctors will be baffled by the illogic. Unfortunately, with new exposure to liability, they will require a patient visit before providing the prescription. This produces an office visit charge and perhaps a follow-up visit. It also reduces access to care for those in real need of a physician visit and attention.

4. To avoid calls, confusion and ensure insurance coverage, expect physicians to start prescribing stronger “real” prescription drugs. That will add costs and increase patient risks of adverse reactions when a simple OTC medication would have sufficed.

5. After spending millions to accommodate consumer needs, drug card vendors will spend millions changing their cards to deny coverage for OTC medications.

While it may not be the biggest problem with ObamaCare, OTC medications are one more example of government control that will inconvenience millions of Americans. Mothers don’t need to be economists to see how just this one item will increase costs, decrease access and lower the quality. None of it helps the patient.

The United Kingdom and Germany follow similar government mandates for getting medications. Using those countries as examples, the Foundation for HealthSmart Consumers estimates that the cost increase for using more expensive prescription medications, more office visits and added pharmacy expenses will total at least $10 billion.

Of course, with congressional calculus, the difference between “saving” $5 billion and costing $10 billion is just a “rounding error.”

ObamaCare is so complicated that few understand all of the details and implications. Certainly the politicians did not think through the unintended consequences. Common sense has taken leave. Come the next election, mothers may be telling many of them to take leave.

For a better understanding of the federal health law and the new preventive care guidelines, go to www.healthreformnavigator.net.

[Ronald E. Bachman FSA, MAAA, is president and CEO of Healthcare Visions, Inc. and a Senior Fellow at the Georgia Public Policy Foundation, an independent think tank that proposes practical, market-oriented approaches to public policy to improve the lives of Georgians. He is also a Senior Fellow at the Center for Health Transformation, the Wye River Group on Health and the National Center for Policy Analysis.]

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