Congress Ducks Responsibility on Medicare by Allowing Back-door Cuts

Facing growing pressures to reduce debts and deficits, politicians are considering extreme cuts to Medicare that will put patients and seniors on the chopping block.

Worse still, instead of taking responsibility for the cuts, members of Congress are using a shameless back door that both allows them to avoid blame for the cuts and prevents patients and doctors from having a meaningful say in what cuts are made.

Members of Congress can effectively control government spending and contain healthcare costs without endangering Medicare. By bolstering preventive-care efforts and investing in innovation, politicians can both cut costs and improve patient outcomes for decades to come. However, such an approach is incompatible with one that relies on extreme cuts. It is imperative that Congress repeal policies that cut Medicare, and focus instead on modernizing and strengthening this critical program.

John Adams said, “Facts are stubborn things,” and the facts on Medicare are clear: Decades of history show that Medicare is the most efficient, cost-effective healthcare delivery system in the United States.

More than 40 million Americans rely on Medicare for affordable care. The growth in per-person spending for Medicare has been significantly slower than private health insurance over the past 20 years. Far from being an overly generous program, Medicare actually denies more claims than all but one of the major health insurers.

Back-door cuts

Politicians know that Medicare is an effective and popular program. That’s why those who want to sacrifice Medicare to the deficit — opposed to removing corporate subsidies on ethanol, sugar or oil, or to raising taxes on millionaires — have created a back-door method, the Independent Payment Advisory Board.

The IPAB, which was created as part of the Affordable Care Act, will have the authority to cut Medicare spending on an annual basis in order to meet strict spending targets. IPAB will be run by a group of unelected officials charged with making critical decisions about patient care and physician payments that Americans will be unable to oppose.

IPAB gives unprecedented authority to a panel of 15 unelected officials who will face no judicial or administrative review. The law gives Congress a way to override IPAB’s recommendations, but it raises the bar so high that, in practice, legislative review is unlikely.

Politicians like IPAB because they can claim to be “fiscal hawks,” but keep their fingerprints off the inevitable harmful Medicare cuts. They can say, “It wasn’t me who cut your Medicare.”

If members of Congress want to balance the budget on the backs of seniors, they should have the courage to do so directly, and not through a back-door mechanism that keeps their faces hidden.

Designed to fail

Though the law gives IPAB unprecedented authority, it also restricts IPAB in ways that almost ensure it will produce harmful results. Instead of spreading cuts across all types of Medicare spending, IPAB will have to make its cuts from a small portion of Medicare.

IPAB cannot cut hospital spending, and, since the Affordable Care Act subjects Medicare Advantage to $145 billion in cuts this decade, IPAB cannot make further cuts there. That leaves prescription drugs — specifically Medicare Part D — and cuts to physician reimbursements.

Medicare Part D has helped make medications affordable for the millions of America’s seniors and patients who need them. Extreme cuts and reforms to Medicare and Medicare Part D will cut access to quality care for seniors, people with disabilities and other vulnerable populations.

Better approach

More than 300 organizations representing Medicare and Medicaid patients, and lawmakers on both sides of the aisle, have expressed concerns over the impact IPAB could have on Medicare patient access to quality care.

Cuts to Medicare and Medicare Part D will only inhibit access to affordable care that improves the health of our nation. These organizations recognize that the best way to strengthen Medicare is through improving preventive-care efforts and investing in innovation.

Controlling government spending and containing healthcare costs will require tough choices: They will require removing corporate subsidies, raising taxes on millionaires and, yes, modernizing Medicare.

But meaningful fiscal reform must not cut access to quality care for seniors, people with disabilities and other vulnerable populations. The IPAB, and other policies focused on extreme cuts to Medicare, are incompatible with this approach, and they should be repealed.