Retail pharmacy returns to primary care


When consumers have to pay for their own healthcare, their first stop will be the corner drugstore. Get ready.

Robert L. MabeeThanks to ACA, in order to accommodate about 3% of the population - about 9 million individuals with “new insurance” - nearly 99% of all taxpayers in the private sector will have effectively less coverage, higher deductibles, and increased co-pays. “Insurance coverage” for routine expenses will be greatly reduced or even disappear. The practical result will be that for much of their routine care, taxpayers in the private sector will become cash customers.

As the most accessible members of the primary care team, pharmacists will be among the first healthcare providers to whom patients will turn. Pharmacists have the training and experience to triage these patients and get them the care they need at the lowest cost possible. Filling these gaps in healthcare, pharmacists will provide invaluable services to many patients overwhelmed by the system.

See also: The pharmacist's role in a changing healthcare landscape

Back to court

This spring the Supreme Court will again review the ACA, and probably not for the last time. Because the writers of the ACA gave little or no consideration to the volumes of state and federal regulations already on the books, much of the ACA and its associated regulations will conflict with existing laws and regulations that have been in place for decades. Legal challenges are likely to proliferate.

For this round, supporters of the ACA in King v. Burwell will argue that “clearly” it was the intent of the bill to provide subsidies for everyone, not just those who bought insurance through state exchanges. They will argue further that it is ridiculous to assume that the drafters wanted to “coerce” states into forming their own exchanges. Yet the Supreme Court has already had to strike down an ACA provision seeking to “coerce” the states to expand Medicaid or lose benefits.

See also: Is the ACA treating America without informed consent?

Elephant in the living room

The ACA provisions under consideration by the Supreme Court directly relate to expansion of the federal budget’s single largest problem, entitlements.

Medicare and Social Security have been funded with taxpayer contributions for decades. For much of that time politicians maintained that those funds were kept in a “lockbox.”

At the same time that the federal government was collecting Medicare and Social Security taxes for the “lockbox,” incumbent legislators were expanding salaries and benefits for themselves, associated unionized bureaucrats, and recipients of food stamps, welfare, and Medicaid. They even set up legislation to protect private and state pension funds and to indemnify those plans from loss. All this was done to keep incumbents in office.


The party’s over

With the proposed expansion of entitlements contained in the ACA, legislators have finally realized that they are running out of other peoples’ money. They have decided the only way to resolve this matter is to increase taxes and decrease benefits for Social Security and Medicare. They no longer talk about the “lockbox”; they would rather punish and blame taxpayers in the private sector for not paying more.

Why should the Supreme Court reverse the Fourth Circuit decision in King v. Burwell and effectively stop the funding for a significant portion of the ACA?

Expanding healthcare spending will not make healthcare affordable. It will effectively decrease the supply and increase the cost for all patients. This is why the ruling elites and their unionized bureaucrats have exempted themselves from “the law of the land.” They don't want to live by it.

The nation has reached a point where the return on investment of additional healthcare spending is declining. Economists would say the marginal product of additional healthcare spending is a negative number. Big Medicine argues that the nation needs to spend more money to cover everyone with insurance.

Only the Political Medical Complex (PMC) benefits from more spending.

Pharmacy opportunity

The President will veto any legislation to repeal the ACA. However, he cannot veto a decision by the Supreme Court. Nor can he veto the reality of the ACA imploding and repealing itself.

We need to reduce healthcare spending, not simply expand insurance coverage. Patients will reduce healthcare spending and lower costs when they think of themselves as consumers, not beneficiaries.

True healthcare reform will come about through reduced costs and increased access. Pharmacies that have increased the number of walk-in clinics and integrated those operations with expanded services from pharmacists will increase their share of the changing healthcare market.

Robert L. Mabeeis a pharmacist and attorney practicing in Sioux Falls, S.D. He also holds an MBA. Contact him at

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