Opinion

A Consensus To Repeal Obamacare’s Medicare Bureaucracy

It may appear that there is nothing in healthcare on which all Americans can agree but looks can be deceiving. There is public as well as political consensus about the Independent Payment Advisory Board (IPAB). Everyone hates it.

Section 3403 of the Affordable Care Act created IPAB as the federal government’s way to reduce spending by Medicare. This program for seniors currently serves 44 million Americans and is expected to have 70 million enrollees by 2030.

The Board of IPAB is tasked with cutting Medicare spending to achieve specified target reductions regardless of effect on care. The cuts are FastTracked meaning they are implemented within one year. The law expressly prohibits the Board from: rationing care; generating new revenues; raising insurance premiums; increasing cost-sharing; reducing benefits; or altering eligibility. That leaves the Board with two ways to cut spending: reduce payments to providers, and as the British NHS does, deny authorization for certain expensive treatments by classifying them as “Not Cost Effective.” Both methods indirectly do exactly what the law prohibits: they ration care.

The IPAB statute prohibits judicial or administrative review meaning that Board’s recommendations automatically become law. Congress has never constituted the Board of IPAB. The ACA specifies that in the absence of a Board, the Secretary of Health and Human Services, former Representative (R-GA) and doctor Tom Price, must precisely mirror what the Board would have done.   He has no administrative leeway.

Republicans and Democrats; right and left; conservative, progressive and everybody in between all oppose IPAB and for good reasons. It reduces care for seniors. IPAB raises costs and grants total control of healthcare to the federal government. IPAB replaces your doctor with a federal bureaucrat who decides your care.

Not only do we have a consensus in opposition to IPAB, there is also a ready solution to hand.

The fix for IPAB is a limited-time-offer built into the original ACA law. This legislative off-ramp goes away on August 15, 2017. Section 1899 of the ACA spells out the details. The bottom line is this: Congress can repeal IPAB as an isolated action without having to do anything with the rest of ACA or applying the Budget Reconciliation procedure if they act before the middle of this August.

Both right and left would win by getting rid of IPAB, and yet there is little movement. Why is that? Answer: the partisan political “game.”

With increasing resistance to the American Health Care Act and a perception of they can’t get anything done, the GOP needs a win. Repealing IPAB is easy, popular, and allows them to claim they made good on their promise to repeal ObamaCare. They can even say they worked together with the Democrats.

Democrats know how unpopular this one part of ObamaCare—IPAB—is with their constituency, especially when the media makes clear that IPAB limits access to care. The left could demonstrate their responsiveness to the public will, show how magnanimous, and how willing they are to compromise by joining with Republicans in repealing IPAB.

Yet, they cannot seem to get together even on the IPAB issue despite the obvious policy advantages and a public consensus.  Both sides of the aisle seem totally focused on winning political points over their opponents. To them, the definition of winning is when the other side loses. Washington has forgotten or is ignoring our definition of a win: when what they do with the power we give them improves our lives.

As a doctor, I must recommend the following. Don’t hold your breath waiting for Congress to repeal the odious IPAB. Let’s demand it, before it’s too late!

Deane Waldman, MD MBA, is Emeritus Professor of Pediatrics, Pathology and Decision Science, and Director of the Center for Health Care Policy at the Texas Public Policy Foundation in Austin, Texas. Dr. Deane is the author of The Cancer in the American Healthcare System. He can be reached at [email protected].