Culturally, we Americans take a pretty reactive approach to our healthcare. When we get a little sick, we pick up some ibuprofen at the drug store and muscle through it. When we get really sick, we make an appointment with our doctor — if we have health insurance. When we get really sick but don’t have health insurance, we wait until we’re at death’s door and then we go to the emergency room.

But, given potential new legislation, this may all be about to change dramatically.

The proposed American Health Care Act of 2017 — or Trumpcare, as it’s commonly referred to — will force patients to rethink the way they interact with the healthcare system, if passed. Patients will have to take far more responsibility for how and where their medical care is administered, experts predict. Higher premiums, copays and other out-of-pocket expenses will force patients to be less reliant on doctors and hospitals, and to seek more of their basic and preventive care — like vaccinations, medication consultation and adherence, birth control prescriptions and diabetes maintenance — from their local pharmacists to keep costs down, a trend which started even before this bill came into being.

One such expert, Al Babbington, the CEO of PrescribeWellness, says, “Public statements from Paul Ryan underscore the shift in the burden of healthcare to the state and individuals, specifically for preventive services like birth control. Community pharmacies and other third parties are already playing a significant role in filling the gap in California.”

“70% of healthcare costs treat preventable diseases,” Babbington continues. “There’s an enormous need for preventive services. Obamacare had mandatory coverage, and 31 states took advantage of expanded services partly funded by the mandate. The Republican majority wants to limit the mandate — they need to save money somewhere — pushing the Medicaid burden to the state to try to figure out how to best support uninsured and underinsured. Care management is willing to reinvent the business model and there’s a big shift to more personal burden: premiums go up and insurance providers can charge five times the basic rate, leading to higher deductibles and higher copay plans.”

Shifting the burden to the individual will have an enormous impact.

For one, higher deductibles and copays will mean that seeing a primary care physician for regular check-ups would become a prohibitive luxury for many. For many others, it will likely mean not being able to afford health insurance at all. These Americans will have a new incentive to keep from getting ill at all costs. This means a renewed focus on both preventive care — smoking cessation, weight management, immunization and health education — as well as the maintenance of chronic illnesses like diabetes. It also means more uninsured Americans will likely end up in emergency rooms when they do get sick — a major burden on our healthcare system already.

“$300 billion is spent due to lack of medication adherence,” explains Babbington. “This is the cost of Americans not taking their prescriptions regularly or correctly and ending up in emergency rooms for preventable conditions that have escalated. The average physician spends less than five minutes explaining medication. This positions the community pharmacy to step in.”

Not all portents are of doom, though. The bill does have some aspects that can be viewed more favorably, such as maintaining protections for preexisting conditions exclusions. And there is evidence from the CBO report linked earlier that families making 400% of the poverty line do stand to save money on healthcare.

However, an increasing number of organizations, including the American Hospital Association, the American Medical Association and the American Academy of Pediatrics, remain opposed to the bill, arguing that the drastic healthcare cost increases will be untenable for many American families — especially those most vulnerable, like the elderly and low-income Americans.

The takeaway here is that patients will need to be increasingly proactive about their healthcare. With a potential bill looming that would make things we may have considered fairly basic like primary care, emergency room visits and prenatal coverage prohibitively expensive, the burden of healthcare will fall more on the shoulders of individuals more than ever before.

Get to know your community pharmacists. You may be seeing a lot of them in the coming years.

Originally published at on March 22, 2017.