Cross Post – New Health Policy Sourcebook Helps You Navigate 2017

hpFrom time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Since we are smack dab in the middle of our focus-month on topics related to health care reform, we wanted to bring attention to a new health policy guide. Produced by the Alliance for Health Reform, with support from the Robert Wood Johnson Foundation (RWJF) and National Institute for Health Care Management (NIHCM) Foundation, the Health Policy Sourcebook has information on a number of topics from Medicare to Medicaid to the Affordable Care Act (ACA) and others. To read this publication, click here.

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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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Putting Patients First: Repeal the Medical Device Tax

scottScott Whitaker
President and CEO of AdvaMed (the Advanced Medical Technology Association)

Creating life-changing innovations is central to the role the medical technology industry plays in improving patient care. For people with neurological conditions — like spina bifida, epilepsy, Parkinson’s, multiple sclerosis and many others — advances in medical technology are not only improving, but also saving lives. Unbeknownst to many, however, is how one harmful tax policy is creating unnecessary barriers to future advances, and negatively affecting those living with chronic diseases and conditions and those yet to develop them, including our children and grandchildren.

The little-known tax wreaking havoc on medical technology innovation is called the Medical Device Tax, a 2.3 percent excise tax on the sales of all medical devices, including innovations for the treatment of complex neurological conditions. Originally passed to help pay for the Affordable Care Act (ACA), the tax is responsible for not only halting the production of the next generation of life-saving technologies, but has also cost the U.S. thousands of jobs.

strokeFor decades, the medical technology sector has been a uniquely American success story, developing innovations that are advancing and improving patient care in the U.S. and around the world. These medical innovations would not be possible, however, without the partnership between our industry and the physicians that use our technologies for the benefit of patients. Together, we have helped add five years to average U.S. life expectancy since 1980 and helped reduce fatalities from stroke by more than 60 percent. Medical technology has also helped people overcome functional limitations, enabling them to continue to live independently in their homes. And disability rates are on the decline — down 25 percent over a 20-year period — with disability-free life expectancy increasing over time.

The industry is proof that fostering innovation can lead to positive outcomes. And that’s why policies that support medical technology innovation are so critical to not only helping patients’ live longer, healthier lives, but also to reducing health care costs and creating good-paying jobs in communities large and small. In fact, the medical technology industry is responsible for nearly 2 million jobs nationwide. But the industry’s potential for continued job creation and its ability to develop the next generation of life-changing advancements is under threat by the continued existence of the medical device tax.

New government data released just last month showed the industry lost nearly 29,000 jobs in the three-year period in which the tax was in effect. These numbers reveal just how devastating an impact the device tax had on our industry and underscore the urgent need for permanent repeal. Congress took a positive step forward in 2015 by suspending the tax for two years. However, if they don’t permanently repeal the tax, it will go back into effect starting in January 2018.

And here’s why that can’t happen. Medical technology research and development is not a stop-start process; it requires significant capital investments committed over many years. And that, in turn, impacts every aspect of a company’s innovation cycle — from workforce retention and job creation to employee compensation and benefits, facility expansion and the medical device R&D pipeline itself. When that R&D pipeline is disrupted, patients lose.

America’s patients deserve better. Patients like Kelly Smith, a long-time nurse who was diagnosed with essential tremor and forced to quit her job due to debilitating symptoms. Kelly is now living virtually symptom-free with the aid of a deep-brain stimulator. Such transformational stories demonstrate the life-changing power of innovation, and should be cause enough for Congress to act now to repeal the medical device tax for good.

Editor’s Note:  In the early morning hours on March 9, 2017, the House Ways and Means Committee advanced part of the American Health Care Act, which would permanently repeal the medical device excise tax.

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