By Deb McGrath
There is certainly truth in the old adage, "practice makes perfect." And in the case of the Affordable Care Act, taking a step back to evaluate what is working and also what can be improved, is the next step toward making a good law even better.
I've seen firsthand how the ACA and the Medicaid expansion provide people living with chronic diseases access to high quality, affordable health care — some for the first time in their lives.
Enrollment numbers that have shattered estimates, along with reduced numbers of uninsured, prove that the new health-care law is working in terms of providing coverage to many Kentuckians.
Yet, even good new programs have growing pains that must be addressed.
That's why the Epilepsy Foundation, along with more than 300 other advocacy organizations from across the country, recently signed onto the I Am (Still) Essential letter urging the Secretary of Health and Human Services to take actions to remedy certain issues with the ACA.
Implementation of the new health care marketplace, Kynect, has highlighted some coverage issues which, if not addressed, could jeopardize access to care for the very people the ACA was intended to protect. For instance, some new enrollees — particularly those with chronic diseases — are facing barriers to care including limited benefits, high cost-sharing and lack of transparency in enrollment choices.
These barriers could have serious consequences for the 90,000 Kentuckians living with epilepsy and seizure disorders.
Epilepsy is now the most common neurological disorder among children and the fourth most common among adults. In fact, more people die each year from seizure-related deaths than breast cancer and AIDS.
While these statistics are staggering, people with epilepsy can live relatively normal lives once they find treatment plans that work and, more importantly, if the treatment plans remain uninterrupted.
Stability in treatment is critical and can only be achieved if patients maintain affordable access to medications and their chosen providers. Some health-care plans do not cover all the medications enrollees may be prescribed. And even if they are covered, confusing prior authorization and complicated step-therapy requirements can also limit access to medications.
For someone with epilepsy who may be living seizure-free for years it is important that they be allowed to remain on the medication that works best for them.
Some plans have even implemented expensive cost-sharing practices on life-saving medications. Many brand-name drugs and even some generics are being placed in the highest cost tier, meaning the most vulnerable enrollees are sometimes paying as much as 50 percent of the cost.
These so-called cost-saving measures can have a significant negative impact both on the physical and fiscal health of Kentuckians.
The good news is that we now have a successful new mechanism that is helping millions access the critical health-care coverage they have so long needed. We just need to fine tune it a bit to make sure it is running properly and in the best interest of consumers.
One place to start is adding a little more transparency in the marketplace to help Kentuckians make more informed decisions during the open enrollment period. Plan benefits, formularies, provider networks and the costs of medications should be readily accessible and easy to understand during the decision making process. An interactive web tool such as the one used for the very popular Medicare Part D prescription drug benefit should be offered to allow beneficiaries to easily navigate how each plan will best fit their needs.
It is our hope that state officials will work with the patient advocacy community to find reasonable and effective solutions to make the ACA work even better.
We've built a great program. But with a little work we can make it even better.
Deb McGrath is executive director of the Epilepsy Foundation of Kentuckiana.