In the Merriam-Webster dictionary, the first definition of the word vacuum is "emptiness of space." A third definition offered is "a state of isolation from outside influences." Both of these conditions apply to the Patient Protection and Affordable Care Act (PPACA) and to the regulatory process now being created as the foundation for implementing that law.
New reports are beginning to surface about doctors' offices being besieged by patients asking for prescriptions. The requests aren't for the usual pharmaceuticals however; they are for a wide variety of over-the-counter medications. Patients are requesting prescriptions so they can purchase these items with funds from their flexible spending accounts (FSAs).
According to the Wall Street Journal (March 9), "To the handful of congressional aides who came up with the idea to limit tax breaks for over-the-counter drugs, it was supposed to be a minor tweak to raise revenue and to discourage wasteful spending on health products." There's that vacuum. Americans have a long history of making the most of any tax-saving device available. It should not have been difficult to foresee this problem — unless you were making law in a vacuum.
The lack of serious, deep input from those of us who actually understand how these markets and consumers operate is not confined to the 33 million Americans dealing with new FSA limitations. As of this writing, the Department of Health & Human Services has granted more than 1,000 waivers to provisions in PPACA. More waivers will undoubtedly follow.
We tried to warn the vacuum dwellers about the dangers that high-risk pools would either be immediately bankrupt or would be so expensive as to be virtually unaffordable. Prices are now so high that enrollment is a fraction of what was anticipated. The population that needs these mechanisms the most can't take advantage of them. Maybe we could get some waivers there, too?
Those who believe that government knows best about running health care should be discomfited. This is what happens when you vilify those who really understand an issue and push them to the outside of the process. PPACA is not even in full force and effect yet, and the simple, initial steps are becoming littered with unnecessarily unforeseen problems.
