By Ethan Rome – Executive Director, Health Care for America Now
Hyperbolic conservative partisans repeatedly (and deliberately) mislabel the Independent Payment Advisory Board (IPAB) as an “unaccountable rationing board” or “the real death panel.” Only in Washington could an expert panel on the critical issue of affordable health care for seniors and people with disabilities beconsidered a threat to liberty.
Congress needs the IPAB for this simple reason: Without it, Congress isn’t likely to propose real solutions to control Medicare costs without hurting seniors, and if they did, they probably would not act on them. The IPAB addresses both of these problems.
The ACA established IPAB as a panel of experts—each one individually confirmed by the Senate—to recommend options for controlling costs when Medicare cost growth exceeds the budgeted target. Inother words, when benefit costs rise, Medicare experts will be asked why that happened and what Congress should do about it. But there will be strict limits on the kinds of solutions the panelists can offer. By law, they can’t cut benefits, can’t raise the eligibility age, can’t increase costs for seniors, and can’t recommend health care rationing. Instead, experts must speak to the root causes of cost growth and deliver a plan of action to Congress for itsconsideration. Congress can accept or reject the proposal. Or in true Washington fashion, it can do nothing and allow the experts’ recommendations to take effect. But Congress will have the power to act if it so chooses. So if, for example, the experts were to make a proposal to cut provider payments to unacceptable levels, Congress could stop the proposal. Despite the hysterical Republican rhetoric, Congress has nothing to fear from the IPAB.
The Sustainable Growth Rate (SGR) saga is a great example of why Congress needs to bring in reinforcements. Congress created a payment formula in 1997 to restrain rising physician costs, but nearly every year after—rightly or wrongly—they have prevented the cost cuts from taking effect. This usually pushes the program’s fiscal deficits to future years and digs the hole deeper. However, Congress has enacted no alternative proposal or formula adjustment to revamp physician payment.
The irony is that the same Republicans who trumpeted the Ryan budget’s unconscionable beneficiary cuts last year are the fiercest voices against the IPAB—a new tool for cutting costs from the system instead of cynically shifting costs to seniors. By dramatically shifting costs to beneficiaries (and eliminating the Medicare guarantee of coverage), the Ryan budget would end Medicare as we know it. For starters, the Ryan budget included a $6,400 out-of-pocket increase for the typical Medicare beneficiary—a price hike that would in fact inflict government-imposed rationing because so many seniors would no longer be able to afford the health care they need.
But let’s be optimistic. Maybe Republicans have listened to their middle-class constituents about the impossibility of Ryan-care. Maybe the Republicans will step forward with a sensible and compassionate budget that keeps seniors’ costs low, maintains Medicare benefits, preserves the current eligibility age, and explicitly prohibits rationing—the same protections they want to erase by repealing the IPAB. One can hope.