Did you resolve to do something ambitious in 2017? GOP lawmakers did: They resolved (even promised) to repeal and replace the Affordable Care Act … and failed.
But there’s still time left in 2017 to make good on this year’s resolutions. And lawmakers have a good chance — with an upcoming vote on Thursday — to undo one of the ACA’s most egregious harms: the Independent Payment Advisory Board, a cost-cutting board for Medicare.
IPAB epitomizes the ACA’s approach to health care: great power concentrated in the hands of a few. The unelected 15-member board would ultimately have the power to cut Medicare spending without Congressional review, impacting the health access of more than 55 million seniors.
The board has never been appointed, and it has never been triggered. If (when) Medicare’s actuaries predict that the program will not meet a certain budget target, the Affordable Care Act empowers the board to make budget recommendations that will bear the weight of law. In the absence of a board, these powers fall to the Secretary of Health and Human Services.
It’s hard to argue about the harm of something that hasn’t happened yet (which is why all reforms to Medicare are so difficult), but IPAB represents a loaded gun that threatens the program in the most undemocratic way. Statutorily, IPAB exists. It’s only a matter of time until it is triggered by budget realities (actuaries now predict in 2021) and begins setting policy.
But there’s strong, bipartisan opposition to IPAB. Liberals don’t like it because they typically oppose any potential cut to social programs. Conservatives don’t like it because it represents the big-government approach to cutting healthcare dollars, which will inevitably result in the backdoor rationing of services and treatments.
Senior advocacy groups like the AARP don’t like it (because of the obvious effect on seniors), and constitutional watchdogs disdain its end-run around the normal budget- and law-making process. Myriad doctors’ groups don’t want anything to come between them and patients, so they oppose IPAB as well.
Now all of these stakeholders have the opportunity to get what they’ve been hoping for: A vote to repeal IPAB is scheduled for Thursday in the U.S. House. This won’t be the first time the House has voted on the controversial board; they actually voted to repeal it as far back at 2012, but the effort failed in the Senate (and of course then-President Obama would not have signed such legislation anyway).
But now the game has changed, along with control of the Senate and the White House. Opponents of the ACA, having failed to comprehensively address the law, now have the chance to target its harmful pieces one by one, and also now with some help from across the aisle.
Supporters of IPAB argue that the board is needed to address Medicare’s runaway spending and keep the program fiscally solvent for future enrollees. They are right to be concerned with Medicare’s unsustainable funding model, where today seniors use $3 of Medicare benefits for every $1 they paid in to the program (on average).
But IPAB is simply the wrong way to reform Medicare. A better approach respects the individual choices of patients, rather than using one-size-fits-all, top-down cuts from an unaccountable government board. Instead of blunt cuts, Medicare needs structural reform that offers seniors more private-sector options for insurance coverage, allowing competition — instead of price controls — to hold down costs.
Although Republicans didn’t make good on their promise to repeal “every word of ObamaCare” this summer, they can take an important step and repeal at least the IPAB. This would be a welcome step toward protecting seniors, and would pave the way for better, patient-centered, market-driven reforms.