Repeal IPAB now

Donald J. Palmisano Former President, American Medical Association
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A number of groups recently sent a letter to GOP leaders in the House of Representatives encouraging them to quash a bill meant to repeal the Affordable Care Act’s (ACA) Independent Payment Advisory Board (IPAB), a panel of 15 unelected bureaucrats empowered to make cuts to Medicare when spending exceeds targeted growth rates.

The signers argue that if the health law is taken apart piecemeal, focus on the ultimate goal — the ACA’s full repeal — will dissipate. Americans will be stuck with most of this harmful law, indefinitely.

Although the signers’ intentions appear pure and their goal admirable, they fail to see that the immediate danger posed to seniors by the IPAB’s creation in 2015 is simply too great to ignore in hopes of the ACA’s full repeal.

As the letter rightly points out, IPAB will essentially mean rationed care for our nation’s seniors. The 15 officials who will make up the board will not only be empowered to make what is expected to be billions of dollars’ worth of cuts to Medicare every year, but will be required to do so when spending exceeds targeted rates. IPAB’s recommended cuts will become law unless a supermajority in Congress vetoes the board’s proposal and creates its own cost-cutting proposal of equal size — an unlikely scenario even in the most harmonious of political times.

Due to the ACA’s restrictions on IPAB’s cost-cutting methods, the board is expected to focus on minimizing payments provided to doctors who serve Medicare patients. However it is no longer financially viable for many physicians to serve Medicare patients as it is, and such cuts would exacerbate a Medicare-doctors shortage that is already affecting patients’ access to care throughout the country.

While this form of rationing would most certainly be harmful to patients who need dependable doctors, a far worse form of rationing could be close behind. For example, IPAB may eventually be allowed to resort to Great Britain’s chosen rationing methods and refuse to provide certain effective treatments to patients who need them based on costs and patients’ remaining “quality adjusted life years.” Though the law currently forbids IPAB from engaging in such behavior, there is little reason to believe these rules won’t be changed — or at least stretched — down the road as costs continue to balloon and political dynamics change.

If the ACA had honestly addressed fundamental problems in Medicare instead of focusing on harmful and ineffective “band-aid” fixes like IPAB, such worries would not concern us today. But the law’s authors put politics over patients and hurried a flawed and unpopular bill though the legislative process. Now, years later, more seniors are beginning to understand that IPAB’s creation and the $500 billion in cuts to the Medicare program meant to help pay for the law were anything but helpful to them.

The signers of the letter may be correct in their theory that deconstructing the health law piece by piece will make it harder for lawmakers to repeal the bill in full. But they also could be wrong, and if Congress misses what could be its last chance to eliminate IPAB — one of the most egregious aspects of the law — it will be doing a disservice to seniors who need good medical care now and in the near-term future.

In short, seniors’ health is too important to play politics with, even when the political goals are commendable. Speaker John Boehner and Majority Whip Eric Cantor must do all in their power to remove IPAB from the books as soon as possible and still pursue larger efforts to repeal the whole Affordable Care Act because of its pernicious effects on the practice of medicine.

Donald J. Palmisano is the former president of the American Medical Association and the spokesperson for the Coalition to Protect Patients’ Rights.