There are several unattractive parts of the Affordable Care Act, but perhaps the most unattractive is a little-discussed board that has the power to dramatically alter Medicare. The Independent Payment Advisory Board has the power to reshape Medicare to meet a budget, and Congress has only limited ability to stop it. It is imperative we move quickly to repeal the board.
Starting this year, the law requires the chief actuary of the Centers for Medicare and Medicaid Services to determine annually by April 30 whether cuts will need to be made to Medicare in the following years. If the chief actuary determines Medicare spending has exceeded the arbitrary target set by a formula, then the Independent Payment Advisory Board will be required to find savings in Medicare. Worse, if the board fails to agree on cuts, then the power falls unilaterally to the secretary of health and human services — potentially giving to one person the power to forever change Medicare.
So what will the process look like when cuts to Medicare are needed? Once the chief actuary makes the determination that cuts must be made, the Independent Payment Advisory Board has until Sept. 1 to send a draft proposal to the Medicare Payment Advisory Commission and the secretary of health and human services for comments, and then must submit its recommendations to Congress by Jan. 15. If the board fails to submit recommendations by Jan. 25, the health and human services secretary will submit a savings proposal to Congress. Should the board submit a proposal, the secretary then has until March 1 to officially comment on the proposal to Congress. Congressional committees must introduce legislation based on the recommendations by April 1, but Congress can only change the types of spending reductions, as it takes a three-fifths vote of the Senate to change the amount. If Congress fails to pass legislation to implement the board’s cuts, the recommended cuts automatically take effect between Oct. 1 and Jan. 1.
The Independent Payment Advisory Board is an unelected, unaccountable body of 15 members. The law does not require the board to be bipartisan, despite its sweeping power to essentially regulate the entire Medicare system. While the law does explicitly state the board cannot ration care, it does not define what rationing is, and I have serious concerns the board’s decisions will lead to reduced access to health care. The board has one mission: to cut Medicare spending to meet a budget. At a time when Medicare currently only pays around 80 percent of what private insurers do, any additional cuts could absolutely limit patients’ access to care. Already, 1 in 10 physicians is not accepting new Medicare patients.
I spent more than 30 years caring for patients, and I know firsthand that few decisions in life are as personal or important as the ones you make with your family about your health care. The Affordable Care Act will forever change the way we deliver health care in this country. I remain convinced that repealing this law and starting over to replace it would be best, but in the meantime, we must address the law’s most damaging aspects. That is why I introduced legislation to repeal the Independent Payment Advisory Board. The Protecting Seniors’ Access to Medicare Act, H.R. 351, has 160 co-sponsors and was referred to the House Energy and Commerce Committee and to the House Ways and Means Committee. In the previous Congress, I introduced identical legislation, which passed the House as part of H.R. 5.
My legislation has something that is all too rare in Washington: bipartisan support. While Republicans and Democrats might not be able to agree on how we should save Medicare for future generations, we do agree that Congress — not government bureaucrats — should make those decisions. My life has been committed to health care. While I have the distinct honor of serving as a U.S. congressman, I will always be a doctor first. The American people deserve a health care system that works for them, not one that pushes them away or prevents them from receiving health care services because they’re deemed too expensive. We can do better than the Affordable Care Act. We can start by repealing the Independent Payment Advisory Board before it has a chance to do real damage to seniors’ Medicare.
Rep. Phil Roe of Tennessee, a physician, is co-chairman of the Republican Doctors’ Caucus.