What if I told you there was a country where medical decisions were made not by doctors in consultation with their patients, but by a panel of 15 unelected bureaucrats who determine the fate of millions of Americans? You would probably think that such a system would only exist thousands of miles off our shores, where access to even the most rudimentary healthcare is reserved for the privileged few. You would be incorrect.
When the Affordable Care Act (ACA) was passed, it created the Independent Payment Advisory Board (IPAB) with the intent of slowing future spending growth of Medicare, which already consumes $468 billion of our federal budget and is projected to rise ever higher. But Congress decided to give the Board unprecedented power to make cuts to Medicare where they see fit, and only a supermajority vote can overturn them. On Wednesday, the House Energy and Commerce Committee’s Subcommittee on Health will vote on HR 452, the Medicare Decisions Accountability Act, which would repeal IPAB and send a clear signal that the American people will only fully except the ACA when all of its fatal flaws, chief among them IPAB, are rectified.
Regardless of one’s opinion of healthcare reform, IPAB will neither increase access nor lower the cost of care for America’s senior citizens. That’s because the Board is tasked only with controlling Medicare spending, which in deciding which providers should be paid what amount, could do serious damage to the sacred doctor-patient relationships Americans rely upon to ensure they are receiving the best care.
Controlling the rate of growth of Medicare spending is paramount if the program is to remain a vital healthcare component for millions of American seniors and disabled individuals. But decisions to ensure the long-term solvency of Medicare must be made by Congress, which is accountable to the American people. Otherwise it’s an unelected board tasked solely with making arbitrary spending cuts that may have severe consequences.
Unlike some of the other challenges with ACA, IPAB should not be branded a partisan issue. In fact, many prominent Democrats who supported the healthcare law were squeamish about the concept of the IPAB before it was included in the final version of the ACA. This is for good reason: it strips oversight of Medicare from Congress and puts it into the hands of an unelected board accountable to no one. And while the ACA takes many positive steps to help Americans obtain healthcare coverage, IPAB’s sole mission to cut Medicare spending by slashing payments will certainly not help America’s seniors live healthier lives.
In addition to the inherent policy flaws, IPAB also carries significant political ramifications for Congressional Democrats seeking re-election this fall. Let’s not forget that the senior vote helped sway the 2010 midterm elections, and as long as IPAB remains intact, Republican challengers will have free rein to tee off on anyone seen sympathetic to the issue. Instead of scrapping the IPAB and taking a key talking point away from the GOP, to date many of these concerns have gone unheeded by champions of the provision. However, there is cause for hope.
Congressional Republicans have been joined by an increasing number of Democrats who realize the Board is both bad policy and bad politics, never a good combination in an election year. And with Congressman Barney Frank recently announcing his opposition to IPAB, the door is open for Democrats who realize IPAB’s flaws, but need the political cover someone with Frank’s stature can provide.
In light of an improving economic climate and increasingly volatile Republican primary campaign, President Obama’s re-election prospects are looking up. However, Congressional Democrats who remain loyal to IPAB are in very real danger of finding themselves on the wrong side of a key senior issue this November, as Democrat-leaning voters and independents will be more than happy to extract a political price via split-ticket votes for any supporters of such a flawed policy.
There’s only one way to avoid this: repeal IPAB and forget that it ever existed.
Former Rep. Klink (D-Pa.) is senior policy adviser at Nelson, Mullins, Riley & Scarborough, a firm that represents healthcare clients with an interest in Medicare policy.
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(Link last retrieved February 29, 2012)
