Super Medicare advisory board is bad policy

Controlling overall health care spending must be a critical component of achieving successful health reform and preserving the quality of care that millions of America’s seniors receive. However, granting an advisory committee relatively unchecked authority, as has been proposed for Medicare, is a seriously flawed policy decision.
 
Signed into law by President Johnson in July 1965, Medicare has helped millions of seniors and disabled persons receive the highest quality health-care options for more than four decades. While the original Medicare program had only two parts, in 2003 Congress passed the Medicare Modernization Act (MMA), which created both Medicare Advantage and a first-of-its-kind prescription drug benefit to help seniors gain access to high-quality medications.
 
From both an access and quality of care standpoint, Medicare has been a resounding success. A recent tracking poll by the Kaiser Family Foundation found that more than two thirds (70 percent) of traditional Medicare enrollees “always” get access to needed care (appointments with specialists or other necessary tests and treatment).
 
Currently, Medicare decisions are primarily made by Congress, with the Centers for Medicare and Medicaid Services (CMS) serving as the program’s administrator. In this role, CMS is responsible for issuing rules and guidance to implement congressional statutes. However, as part of a final push for health-care reform, Congress, under pressure from the White House Office of Management and Budget, is considering the formation of the “Independent Payment Advisory Board (IPAB)” to both recommend and formally implement changes to the Medicare program.  This new, independent and unelected body of individuals would have unprecedented power to set payment rates and make other Medicare policy decisions. Such unilateral authority could be devastating to seniors’ access to necessary medical services.
 
As a result of existing cost containment policies, Medicare payments total approximately 80 percent of private health insurance payments to physicians and about 70 percent of payments to hospitals according to the Congressional Budget Office (CBO). The process established through the Independent Payment Advisory Board to single out Medicare for repeated spending reductions, in addition to the $400 billion in provider payments included in health care reform legislation, would widen the current gap in payments to providers to levels that would inevitably result in access problems for Medicare beneficiaries.
 
Should an IPAB-like structure be adopted, this process could easily go well beyond mere technical adjustments in payments.  It could detrimentally alter seniors’ Medicare services by changing payment and coverage policies that may affect what type of services or providers a beneficiary will have access to, while also altering or removing beneficiary appeals protections.
 
There is no mandated role for consumers in the Board membership. The Senate proposal establishes a “consumer advisory council” to advise the Board on the impact of payment policies.  However, there is no requirement or guarantee that beneficiary views would be represented in the consumer advisory council. Under the proposed structure, beneficiaries who oppose the Board’s spending cuts would find limits in their elected representatives’ ability to help. Congress could  reject the Board’s specific recommendations, but only by passing a bill that achieves the same spending cut targets.  Those who object to the targets themselves would have no recourse, as most of the Board’s decisions are also exempt from judicial review.
 
With health reform in its final phase, we have both a fundamental and historic opportunity to join together and improve the system for all Americans. Regardless of party affiliation, cost reductions without sacrificing quality of patient care must be priority one. However, targeting Medicare for additional savings outside of system-wide savings in health spending, usurping the authority of Congress, and silencing the voice of beneficiaries is not the answer.
 
Rep. Ron Klink, a Democrat and former Member of Congress from Pennsylvania, is president of Ron Klink & Associates. Rep. Deborah Pryce, a Republican, is a former Member of Congress from Ohio.