IPAB is not the way to lower Medicare costs

By Reps. Charles Boustany Jr. (R-La.), Phil Roe (R-Tenn.), Tom Price (R-Ga.), Phil Gingrey (R-Ga.) and Larry Bucshon (R-Ind.)

This piece first appeared in The Hill on June 5, 2012

Robert McNamara, who served as secretary of Defense in the Kennedy and Johnson administrations, stated in a 2003 documentary: “Never answer the question that is asked of you. Answer the question that you wish had been asked of you.” Health and Human Services Secretary Kathleen Sebelius has followed this advice religiously, refusing to answer important questions from members of Congress about how the Independent Payment Advisory Board (IPAB) could limit seniors’ access to medical care. Instead of responding honestly to specific concerns raised during the past two years regarding the administration’s healthcare law, Sebelius instead repeated poll-tested language on completely unrelated topics. As physicians and lawmakers, our consciences do not allow putting off important questions for political purposes, and we are working hard to protect the quality care our seniors deserve.

There is bipartisan concern that the IPAB could harm Medicare and limit access to care for seniors. The IPAB is a panel of 15 unelected, unaccountable government bureaucrats empowered to “reduce the per capita rate of growth in Medicare spending.” In the text of the healthcare law, it states that while the law prohibits “any recommendation to ration health care,” it does not prohibit slashing payments to physicians and other medical providers.

Members of Congress from both parties have voiced concerns that such cuts could lead to fewer medical providers accepting Medicare benefits and limit seniors’ access to care. If that’s not rationing, we don’t know what is.
Members of Congress raised this issue with Sebelius at two separate hearings before the House committees on Energy and Commerce and Ways and Means. The secretary testified she was “certain” her department would define the term “rationing” when writing regulations. Unfortunately, she would not agree to prohibit IPAB from jeopardizing seniors’ access to care. According to language in the healthcare law regarding the IPAB, it only acknowledges physician access to the “extent feasible” when meeting mandatory spending targets.

Forty-eight House members wrote to the secretary in March, warning: “We do not believe you can fix this fatally-flawed provision through regulations. … Please specify whether or not you intend to prohibit IPAB from pushing Medicare cuts that limit seniors’ access to needed care, and describe the scope of your authority to do so.” The secretary essentially brushed off this letter, including concerns it raised about the board’s limits on necessary clinical expertise and the lack of public comment on IPAB decisions.

Our concerns over IPAB are real and substantive. For example, cuts proposed by the IPAB are to be considered using fast-track procedures, and without a three-fifths vote of the Senate, Congress can only modify the type of cuts, not their size. Should Congress fail to act on the board’s recommendations, they automatically go into effect. And it gets worse — the IPAB’s decisions cannot be challenged in the courts.

Even supporters of the law agree that the IPAB could harm seniors with dangerous Medicare cuts. AARP said the board could “have a negative impact on [seniors’] access to care.” Former House Minority Leader Dick Gephardt (D-Mo.) has written that IPAB actions “are likely to have devastating consequences for the seniors and disabled Americans who are Medicare’s beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.”

The IPAB is both unaccountable and unworkable, and we need to focus on repealing it before it affects the care of our seniors. It is important to shine light on the dangers posed to seniors by the IPAB; in turn, the secretary should be giving real answers to members’ concerns.

We’re hopeful the Supreme Court will overturn ObamaCare in its entirety. We should focus on better ways to lower costs while protecting the doctor-patient relationship. If we do nothing, Medicare physician payments could fall to “less than half of the projected Medicaid rates,” according to Medicare’s actuary. Seniors will suffer as provider payments fall below the cost of providing care. Questions about physician access will not go away, despite the secretary’s refusal to have a frank and open discussion about Medicare’s future.

Boustany, Roe, Price, Gingrey and Bucshon are all medical doctors.