Repealing IPAB: Bipartisan Health Care Reform We Can All Agree On

roeGuest post from Representative Phil Roe, MD (R-Tenn.)
Chair, House Committee on Veterans’ Affairs
Member, House Education and Workforce Committee
Chair, House GOP Doc Caucus

As a physician who has lived through a massive expansion of Medicaid in my home state of Tennessee, I have had serious concerns about the Affordable Care Act’s (ACA) effect on our health care system since this misguided law was first passed. The ACA started with a good premise: expand coverage for Americans, lower the cost of care, and improve the quality. Unfortunately, while the number of Americans who are uninsured has dropped, costs have skyrocketed. Now, around the country, we are seeing fewer and fewer insurers willing to participate in the program, which will affect both access and quality. For me, this issue has always been about patients. I never once treated a Republican or Democrat cancer in the more than 31 years I spent practicing medicine, and I’ve never been able to understand why we approach health care reform in such a partisan manner. Republicans in Congress offered ideas to Democrats when the ACA was passed, and not a single one was allowed to be debated, much less included.

ipabDespite the partisanship that accompanied passage of the ACA, there are parts of this law that have earned bipartisan criticism, one being the Independent Payment Advisory Board (IPAB). The IPAB is a board of 15 unelected, unaccountable bureaucrats created to reduce Medicare spending. The IPAB, once triggered, makes recommendations regarding cuts to Medicare without any Congressional oversight or input. IPAB proposals are considered using “fast track” procedures and, absent a three-fifths vote in the Senate, only allows Congress to modify the type of cuts to Medicare, not the amount. If Congress fails to act on the board’s recommendations, they automatically go into effect. To make matters worse, the IPAB is exempt from any judicial or administrative review. Further, if the president doesn’t nominate anyone to serve on the IPAB, or if the IPAB fails to recommend Medicare spending reductions, the law gives the Secretary of Health and Human Services an enormous amount of power, allowing them to make changes to Medicare spending unilaterally. This means one person could have the power to drastically shape Medicare spending with no accountability to Congress, the administration or — most importantly — the American people.

There is bipartisan agreement in Congress that the IPAB is a gross overreach of power, which is why I have worked tirelessly since ACA was signed into law to push bipartisan, bicameral measures to protect seniors’ access to Medicare. Last month, I introduced, along with Rep. Raul Ruiz (D-Calif.), two bills that would repeal the IPAB. The first, H.J. Res. 51, would allow the Senate to utilize a “fast track” parliamentary mechanism to repeal the IPAB. The second, H.R. 849, the “Protecting Seniors’ Access to Medicare Act,” is the same bill I have introduced in previous Congresses to repeal the board. Both measures have bipartisan support.

The IPAB has raised red flags throughout the medical community, and more than 600 patient advocacy, physician, and specialty organizations have supported my legislation to repeal the board. While we certainly need to take steps to preserve Medicare for future generations, I have serious concerns, concerns shared by Republicans and Democrats alike, that the IPAB could drastically cut Medicare benefits with little to no Congressional oversight. In fact, Peter Orszag, former President Obama’s Budget Director who strongly supported the creation of the IPAB, called it the “single biggest yielding of power to an independent entity since the creation of the Federal Reserve.” As a practicing doctor, I remember all too well what happened when the sustainable growth rate (SGR) grew into a problem that affected patients’ access to care. We must not allow the same thing to occur with the IPAB.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #HealthReform.

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