It was just the first step on a long journey through the Washington legislative process.
But for Indiana’s more than 1 million seniors on Medicare, a recent bipartisan vote to repeal a controversial provision of President Obama’s health care law is especially good news.
A congressional subcommittee voted to do away with the Independent Payment Advisory Board, a creation of the Affordable Care Act that is supposed to help cut Medicare spending but will end up severely restricting seniors’ access to needed drugs, physicians and hospitals.
There’s no question that Medicare faces a fiscal crisis – it could go bankrupt in as few as 10 years. But IPAB is the wrong prescription to save it.
First, the board’s 15 presidential appointees will have unprecedented power to make decisions on Medicare spending. Under the law, if Medicare’s budget exceeds certain preset limits, starting in 2015 IPAB will be responsible for dictating cuts to bring costs in under those caps.
IPAB can’t, however, make any changes to Medicare benefits, deductions or eligibility. Its only real option will be to cut payments for doctors, prescriptions and, eventually, hospitals.
These payment cuts will only worsen an already-growing access problem for our seniors. Medicare’s payment rates to doctors are already so low that many are getting out of the Medicare business. A survey by the American Academy of Family Physicians found that by 2009, 13 percent of family doctors weren’t taking Medicare patients, up from 6 percent just five years earlier.
An American Medical Association survey found that nearly a third of primary-care physicians restrict the number of Medicare patients they will see.
Letting IPAB dictate still more draconian payment cuts will only force more physicians to abandon seniors.
Worse, the cuts will also likely exacerbate a troubling physician shortage that is pinching Indiana and the country as a whole.
In January, Indiana’s Department of Health declared doctor shortages in two counties. A report from Indiana University found the state needs at least 5,000 more physicians, especially primary-care doctors.
As the huge baby boom generation retires, the demand for physicians will only go up.
The last thing we should be doing in the face of these trends is giving physicians still more reason to close their doors to Medicare patients.
Backers of IPAB claim the law specifically prohibits the board from rationing care. But denying seniors’ access to providers is just a hidden form of rationing.
The second troubling problem with IPAB is that it undermines the country’s democratic system. IPAB is an unelected and largely unaccountable board.
It has the ability to impose Medicare cuts without congressional approval, and the law places the panel’s decisions beyond legal challenge. Once IPAB puts together its package of cuts, they take effect automatically unless lawmakers can gather up a supermajority of votes to block them.
As President Obama’s former budget director Peter Orszag put it, IPAB has an enormous amount of potential power.
A more apt description is the one offered by Rep. Pete Stark, D-Calif., who called IPAB a mindless rate-cutting machine that will endanger the health of America’s seniors and people with disabilities.
Unfortunately, even as more and more lawmakers realize the need to dismantle IPAB, Obama wants to turbocharge it.
In his latest budget, he proposes to lower Medicare’s spending caps even more and grant IPAB still more powers to enforce them.
We must address Medicare spending. But we must do this in a way that brings all the affected parties together to work out solutions that reduce costs without unduly harming the quality of health care provided our seniors.
IPAB doesn’t come close to meeting that standard, which is why Republicans, Democrats and a huge number of organizations – ranging from the AIDS Institute to Easter Seals to the Indiana Health Care Association – have come out against it.
The recent bipartisan subcommittee vote was a first step toward protecting seniors from the mindless and potentially deadly IPAB machinery. Now the rest of Congress needs to finish the job.