What We're Reading: Is There a Future for the ACA?


What we're reading, October 3, 2016: President Barack Obama's Affordable Care Act will have to change to survive; pharmacy benefit managers getting blamed for rising drug prices; and veterans could go without health insurance because states won't expand Medicaid.

Republicans and Democrats can agree on few things, but one is that health insurance still costs too much for too many Americans. According to The New York Times, it seems apparent that the Affordable Care Act will have to change in order to survive. Democrats are pushing for a public option and calling for more government. Meanwhile, Republicans are advocating for less government with reduced regulation and more no-frills insurance options.

Pharmacy benefit managers (PBMs) are getting blamed for rising drug prices. Drug makers are downplaying their own role and pointing fingers at PBMs, which play the middlemen and oversee drug-benefit plans for employers and insurers, reported The Wall Street Journal. The rebates that PBMs use to help hold down the cost of providing benefits mean PBMs benefit from rising drug prices and have encouraged drug makers to increase prices, some say.

The reluctance of 19 states to expand Medicaid could mean that hundreds of thousands of veterans will go without health insurance in 2017. NBC News reported that overall, more than 600,000 veterans will not be able to pay for medical care, but more than half live in states that have not expanded the program. More than 120,000 fall into the Medicaid gap—they make too much money to qualify for subsidies on the Affordable Care Act exchanges, but they are not poor enough to qualify for Medicaid. In addition, they don’t all qualify for care by the Department of Veterans Affairs.

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