Congress needs to repeal the Independent Payment Advisory Board

Now is a particularly difficult time to enter into any debate on health care in our country without the expectation of strong partisan divide. However, there is an opportunity that has bipartisan support and a need for action right now. 

When I served in Congress, I was actively involved in the development and passage of the Affordable Care Act (ACA). I fought to be sure it met a number of goals, one of which was to reduce costs in health care through improving access to coverage, focusing on primary care, early treatment of disease, and numerous ways to encourage care to more cost effective for government and affordable for consumers.

{mosads}I am proud of the important work that is the result, bringing changes right now across the country in doctors offices, hospitals, and community care to improve quality and bring down costs in Medicare.

However, not everyone was convinced that all the efforts underway now would happen or happen fast enough. To be sure costs could not grow faster than inflation, the Senate added a provision in the ACA hat many of us thought, even at the time, was the wrong way to bring down costs.

In fact, I was one of the first Democrats to publicly oppose the creation of what is called the Independent Payment Advisory Board (IPAB) and I supported Republican legislation to repeal it. IPAB repeal is now a bipartisan effort, but it has not been taken up or passed. And time is running out on a chance to stop it.

Here is how IPAB is supposed to work and why it is a bad idea.

IPAB is a board appointed by the president, with the sole authority and responsibility to cut Medicare. They are accountable to no one. If costs in Medicare rise above a certain level of inflation, cuts to bring those costs have to be made and implemented in one year. The law also says that if the President does not appoint this Board, then the Secretary of Health and Human Services has the sole discretion to make these cuts. New revenues or other actions to cover costs are not an option. 

Why is this a problem for Medicare and the 55 million beneficiaries who rely on it? 

Neither IPAB nor the Secretary of HHS is accountable to the voters. Given the importance of Medicare and the potential impact, our elected representatives should be involved in making this kind of major decision about Medicare. Second, the cuts have to be made in all in one year. Estimates of potentially as much as $1 billion in cuts in 2019 would mean everyone could be affected. Third, there is no requirement that the cuts be done in a way that improves care or targets waste or inefficiencies. If these cuts are across-the-board cuts, they cut important services including new innovations happening to reduce costs in the right way. 

While beneficiaries are not supposed to be hurt, there could be cuts to payment to doctors or to innovative programs like telemedicine, nurse care managers, or care in the home —all of which could have a negative impact on Medicare beneficiaries.

This is not only unwise, it is unnecessary. Medicare is in the process of transitioning from the outdated and inefficient fee-for-service payment structure to one that pays for value. New payment systems are underway that focus on high-value treatments, therapies, and interventions that promote better outcomes. We should be doing all we can to drive these positive changes in Medicare, particularly for those with chronic conditions.

The success of this kind of care is evident in the achievements in Medicare Advantage, which is a public-private partnership that is driving innovations and tailored services for millions of beneficiaries through care coordination, supplemental benefits, and patient engagement.

IPAB won’t help any of this important work and is potentially destructive both to these positive efforts and to Medicare.

Congress needs to act and repeal IPAB this year.

I am proud to have built a strong bipartisan consensus on Capitol Hill to oppose IPAB. Now, as I work to strengthen the innovations in payment and care delivery that bring the promise of better, cost effective care for Medicare beneficiaries, I ask Republicans and Democrats to act on their bipartisan agreement that IPAB should not be implemented. Millions of Medicare beneficiaries will be grateful that you took action to stop this harmful and unnecessary idea from being a reality.

Allyson P. Schwartz is President and Chief Executive Officer of the Better Medicare Alliance and is a former U.S. Representative from Pennsylvania.