How an independent panel could ration Medicare services
There is currently an opportunity in the US Senate to repeal the Independent Payment Advisory Board (IPAB) which currently holds the power to make arbitrary reductions from Medicare. At present any changes that the IPAB makes are mandatory unless legislation is passed by Congress with a two-thirds majority. IPAB itself is only triggered once Medicare spending reaches a certain spending threshold, at which point the President must appoint a 15-member commission to address the budget costs. This system is neither transparent nor a guarantee of consumer representation, with IPAB obliged to implement any cuts it proposes at a fast pace. Such a move would pose a risk to Medicare beneficiaries, exacerbating current issues with physicians and specialists unable to accept new patients. These cuts would endanger the half of Medicare beneficiaries who earn less than $23,500, and the seniors that depend on Medicare programs for assistance. There is strong bipartisan support for repeal of the IPAB, with one bill already passed in the house calling for immediate repeal and further legislation pending in the Senate. Indeed, one vote has already been passed to deny any funds to establishing the IPAB. Should the IPAB be called into action, it may represent the first time that Medicare has its care and services rationed.

Dec. 7 marks the end of the 2017 Medicare open enrollment period. The goal of open enrollment is for Medicare beneficiaries to be able to choose the best possible plan for their needs. The U.S. Senate has its own opportunity to help promote greater choice for older adults in Medicare by joining the House in voting to repeal the Independent Payment Advisory Board (IPAB).

IPAB was included as a last-minute addition to the Affordable Care Act (ACA) in 2010. It would establish a 15-member commission all appointed by the president and vested with the responsibility to make arbitrary reductions in Medicare. These changes would be mandatory and would automatically become law unless Congress passed legislation by a two-thirds majority to make equivalent cuts.

IPAB’s inherent danger exists in both its composition and its mission. Appointees would not be subject to Senate confirmation and there would be no guarantee of consumer representation. Further, we don’t even know who these people will be — the president isn’t required to name members until Medicare spending reaches a certain threshold, triggering IPAB.

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The Independent Payment Advisory Board would not only make recommendations for cuts — it would also be required to implement these spending cuts rapidly, perhaps within a year. This could lead to payment cuts to providers and could exacerbate the current problem of physicians, particularly specialists, not accepting new Medicare patients.

Half of Medicare beneficiaries earn less than $23,500 a year, or just twice the poverty limit, according to Census figures. Any cuts to Medicare or program coverage limits would have a dire impact on these vulnerable seniors who are dependent on Medicare and other programs for assistance.

The work of IPAB would result in Congress abdicating its more than 50-year responsibility in setting Medicare policy. Passing this responsibility to a small group of unelected and unaccountable individuals is unfair and dangerous to the future of Medicare and those it serves.

The opportunity exists to repeal IPAB before it is ever convened. The Senate could join the House and pass a bipartisan bill, House Resolution 849, to repeal IPAB immediately. Or there is already bipartisan legislation pending in the Senate on IPAB repeal which could be considered. One of these bills is sponsored by Sen. John Cornyn, R-Texas; the other bill is sponsored by Sen. Ron Wyden, D-Oregon. Clearly, this issue transcends the partisanship often associated with the ACA.

A vote on IPAB repeal could happen this month in the Senate. A separate bipartisan vote was taken by Congress to prevent any funds to be spent to establish IPAB. It is time to take the ultimate step and repeal IPAB once and for all.

As advocates for older adults both in San Diego and nationally, we work to protect beneficiary access to the essential care and services provided by Medicare.

There are ways to improve the health care system and strengthen Medicare’s solvency at the same time — using more electronic health records, providing more innovations in delivery systems and treatments, and focusing more on outcomes. Some of the reforms in the ACA have already accomplished this. IPAB would set us back and possibly introduce rationing of care and services for the first time in Medicare’s history.

It’s a safe assumption that many older Americans who depend on Medicare have no idea about the cuts Medicare will be facing. It’s an even safer assumption that once IPAB-related cuts impact them, these seniors will be angry. After all, 89 percent of seniors want Congress and President Trump to “keep the promise and integrity of Medicare without cuts to the program,” according to a 2016 Morning Consult poll. The same poll found that only 9 percent of seniors think that “government officials should be able to make changes to Medicare without the approval of Congress.”

We call on California Sens. Dianne Feinstein and Kamala Harris, both dedicated supporters of Medicare and those it serves, to support IPAB repeal and keep the job of Medicare reform where it belongs — in Congress.

Blancato is executive director of the National Association of Nutrition and Aging Services Programs based in Washington D.C. and board chair of the American Society on Aging. Downey, past chair of the California Commission on Aging, is the president and CEO of Serving Seniors in San Diego.