Opinion

Move over mom, here comes ObamaCare

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Ron Bachman
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      Ron Bachman

      Ronald E. Bachman is president and CEO of Healthcare Visions, a thought leadership firm dedicated to advancing ideas and policy initiatives that are transforming the U.S. healthcare market. The major goals of Healthcare Visions are to advance consumer-based solutions to lower the number of uninsureds, improve mental health coverages, develop the concept of consumer-centric Medicare and Medicaid, and advance employer introductions of healthcare consumerism.

      Mr. Bachman is also a Senior Fellow of the Center for Health Transformation (CHT), the Georgia Public Policy Foundation (GPPF), the National Center for Policy Analysis (NCPA), and at the Wye River Group on Health. Mr. Bachman is an actuary with extensive experience in healthcare strategy for payers, providers and employers. Ron is a retired partner from PricewaterhouseCoopers where he consulted to a broad range of clients including: employers, HMOs, hospitals, physicians, indemnity carriers, BlueCross BlueShield plans, as well as State and Federal Agency clients.

      In 2008 and 2009, Ron facilitated the Georgia Uninsured Work Group and the passage state health reform legislation to reach 500,000 uninsured in Georgia. That legislation has been praised as a new market-based approach to dealing with the uninsured in the United States. Ron is actively working with other states to pass similar reforms and create a coalition of like minded state desirous of market based solutions. As a Sr. Fellow since 2005, Ron has worked on special projects with CHT and Speaker Gingrich regarding the uninsureds, health policy issues, and market transformation ideas.

      In 2008, Ron has testified before the U.S. Congress on “Engaging American Ingenuity to Solve the Uninsured Problem.” Ron worked closely with the Bush White House and Treasury on the language and principles of the 2002 Health Reimbursement Arrangement (HRA) guidelines. In 2003 and 2004, Ron worked through the CHT to provide policy input on Health Savings Accounts (HSA). Ron has consulted with various government agencies on national health issues and legislative and regulatory proposals. He has served as a designated expert on actuarial issues to the Centers for Medicare and Medicaid Services, the Congressional Budget Office, the Department of Labor, the National Institute of Mental Health, and several members of Congress.

      Ron was instrumental in providing technical and market advice on mental health that resulted in the passage of the 2008 Wellstone-Domenici Parity Act. Mr. Bachman was an expert resource on mental health policy to several members of Congress, including Senator Ted Kennedy and Senator Pete Domenici. During the past two decades, Ron testified in over 30 states on the costs of mental health. He produced several financial studies and analyses of national and state proposals for mental health parity.




      Ron is active in several American Academy of Actuaries Work Groups including: Mental Health, Individual Health Insurance, Consumer-Driven Healthcare, Genetic Testing, Mandated Coverages, High Risk Pools, The Uninsured, Small Group, and Healthcare & Tax Credits.

      Mr. Bachman is the author of several publications, including “Consumer-Driven Healthcare – The Future in Now”, “Giving Patients More Control” published by the National Center for Policy Analysis. He has written numerous articles such as, “Boomers Will Revise an Aged, Ineffective System” and “Consumer-centric Medicare” both articles co-authored with Newt Gingrich, founder of the Center for Health Transformation. As an advisor to the Wye River Group on Health (WRGH), Mr. Bachman was instrumental in three seminal reports entitled “An Employer’s Guide to Patient-Directed Healthcare Benefits”, “An Employer’s Guide to Health Care Consumerism”, and “An Employer’s Guide to Pharmaceutical Benefits.” Ron is a member of the American Academy of Actuaries Mental Health Parity Work Group that produced the 2005 report entitled, “Mental Health Parity: Often Separate, Usually Unequal.”

      A sample listing of other articles and papers written by Mr. Bachman are: Healthcare Consumerism – the basis of a 21st Century Intelligent Health System; HSAs Myths and Facts –The Inconvenient Truths; Clinical Depression – A Bottom Line Issue, If CEOs Only Knew; A Legislator’s Guide to Creating an HSA State; Consumer-centric Medicare; A Roadmap for Legislators on Market Reform for Health Insurance; and Georgia Collaboration Succeeds in Market Reforms.

      Ron is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries, a past Board member of the Southeastern Actuaries Club, and past President of the Atlanta Actuaries Club. Mr. Bachman is on the Board of Directors of the National Mental Health Association of Georgia, the Georgia Free Clinic Network, and Skyland Trail.

      Ron holds a Masters in Actuarial Science from Georgia State University and a Bachelor of Science in Applied Mathematics from the Georgia Institute of Technology. He is an active member of the Simpsonwood United Methodist Church in Atlanta, Georgia.

In most families, moms are the caregivers. They know the right cough medicine, the right dosages, the difference between aspirin and Tylenol, and what to do for their child’s allergies. Most moms have a box or tray with all kinds of cures for their children. Mom’s “medicine box” is there to fix middle-of-the-night pains and fevers. God bless moms.

Relief may range from chicken noodle soup to special itch-soothing creams. Moms handle most issues with love and with the right choice of home remedies and over-the-counter (OTC) medications. If it’s not in “the box,” a quick trip to a local 24-hour pharmacy will secure the needed treatment. If mom’s self-care and time doesn’t make the hurt go away, a doctor’s visit may be in order, with a prescription to be filled at the local pharmacy. But in most situations, a caring mom, Mother Nature, and over-the-counter medications will allow us to avoid unnecessary expenses and doctor visits. 

For years, consumers have been encouraged to use lower cost generics and even less expensive OTC medications. In the past five years, more than 20 million Americans have purchased account-based health insurance in the form of health savings accounts (HSAs) and health reimbursement arrangements (HRAs). Millions more use flexible spending accounts (FSAs). Many use a plan-provided debit card to pay for medications. As part of their insurance plans, families can use these accounts to purchase OTC medications such as prenatal vitamins, antacids, allergy medicines, pain relievers, and cold medicines.

So, what changes under ObamaCare? Read for yourself. Section 9003 of ObamaCare states: “A drug is a prescribed drug determined without regard to whether such drug is available without a prescription.” What??? Translation from government-speak: Effective January 1, 2011, an OTC medication needs a doctor’s prescription 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 to require a mom, who is treating a sick child at 3am, to get a prescription for an OTC medication. That trip to the 24-hour pharmacy just got “government complicated.”    

In the government world of economics, the new provision for OTC medications was estimated to save more than $5 billion dollars. Why? Because they assumed that moms will just pay cash and not get it covered by insurance reimbursable under tax-advantaged HSA, HRA, or FSA accounts. But here’s what is likely to happen in the real world:

  1. Moms, pharmacists, doctors, and children will be confused and outraged by the new restrictive rules. They won’t understand why they need a “prescription for non-prescription medications.”
  2. Pharmacists and checkout clerks will only be able to shrug their shoulders and state during the cash register denial, “That’s ObamaCare. Here’s your change.” 
  3. Moms will need to take children to the doctor’s office to get a prescription for any OTC medication.
  4. Doctors will be baffled by the illogic of a request for a prescription for a non-prescription medication. Of course, with new exposure to liability, they will need to see the patient before prescribing anything. This produces an office visit charge, maybe a follow up visit, and makes access to care harder for others in real need of physician attention.
  5. To avoid calls, confusion, and assure insurance coverage, physicians are likely to start prescribing stronger “real” prescription drugs. That will add costs and increase the risk that patients will have adverse reactions to prescription drugs in situations where a simple OTC medication would suffice. 
  6. After spending millions to accommodate consumer’s needs, drug card vendors will spend millions changing their cards to deny coverage for OTC medications.