The older we get, the more we rely on healthcare professionals. This dependence is a big reason many seniors are so close to their doctors.
That relationship is why I am so concerned about the Independent Payment Advisory Board, a panel of 15 presidential appointees who could soon be given the authority to impose major, somewhat arbitrary cuts to Medicare.
Those cost-saving measures are bound to force patients to pay a greater share of their healthcare costs and make it harder for doctors to accept new patients covered by Medicare. The cuts might even make it too expensive for some physicians to maintain their existing load of Medicare patients, jeopardizing the close patient-doctor relationship many seniors enjoy.
Some 55 million Americans depend on Medicare to cover some or all of their health care costs. The Independent Payment Advisory Board (IPAB) was created to slow the growth of that program. Congress included it in the Affordable Care Act to help offset the costs of covering millions of Americans who previously lacked health insurance.
The board has been given wide latitude to find savings in Medicare. Many patient advocate groups expect the 15-member panel to recommend fairly significant cuts to the program. That changes could force seniors to pay a large share of their healthcare costs.
This is particularly troubling at a time when half of the people on Medicare earn less than $23,500 a year, which is just twice the poverty limit, according to Census figures. Any direct cuts to Medicare or limits on what the program covers could have a dire impact on many of these seniors who depend on Medicare and other assistance programs just to survive.
The worst part is that many older Americans who depend on Medicare have no idea that the cuts are coming. The president isn’t required to name members of IPAB until Medicare spending eclipses a certain growth threshold. The program missed that target in 2016, but most experts, including Medicare’s trustees, think it will blow past that level later in 2017, triggering the board’s formation.
Once the board kicks into gear, Congress has very little recourse to reverse its recommendations. A two-thirds majority is required to overturn the entire bucket of changes IPAB recommends for Medicare. And lawmakers don’t have the authority to pick out specific things they don’t like because they must consider all of the changes as a single package.
IPAB is like using a sledgehammer to pound in a nail; it might accomplish the task, but it will certainly break other things in the process. There are smarter ways to achieve Medicare savings – more utilization of electronic health records, more innovative treatments and delivery systems, and a greater focus on outcomes.
The silver lining in this cloud for seniors is that there is growing agreement among Republicans and Democrats alike that Congress must step in to block IPAB before the panel is even formed. For example, in this last Congress, an IPAB repeal bill was introduced by Reps. Phil Roe (R-TN) and Linda Sanchez (D-CA), and it drew 19 additional Democratic co-sponsors, including one member of the leadership, Rep. John Larson (D-CT), and a prominent member of the House Ways and Means Committee that oversees Medicare, Rep. Bill Pascrell (D-NJ).
These lawmakers and others are joined by more than 650 advocacy groups from around the country who represent various patients and providers who could suffer if IPAB is formed. This coalition has already sent members of Congress a letter urging them to take immediate action to repeal IPAB early next year. I proudly serve as Executive Director for one of these groups, the National Association of Nutrition and Aging Services Programs.
Much of the discussion about this board has been lost among all the clamor about repealing the Affordable Care Act in its entirety. This push to repeal the entire health law would be just as bruising as the fight to establish it, fostering more disunity in an already splintered country. And it would likely take years for lawmakers to agree on a suitable substitute.
Instead, wouldn’t it be more productive to start with an issue on which there is more bipartisan agreement? Nine in 10 seniors want Congress and the new president to “keep the promise and integrity of Medicare without cuts to the program,” according to a recent Morning Consult poll. Three-quarters of all respondents opposed any limits on treatments or medication.
It’s safe to assume that many seniors have no idea that a group of 15 unelected officials could soon have the authority to dictate what Medicare will cover and what it won’t. It’s an even safer bet that many of these same seniors will be furious once IPAB-related cuts impact them directly. Just imagine the uproar.
Congress should intervene before we even reach that point by repealing IPAB and making sure seniors get to keep the doctors they have.