Medicare Must Remain a Responsibility of Congress

As is the case with any legislation, there is room for improvement in the Affordable Care Act. Specifically, we should eliminate the IPAB, a board of unelected officials responsible for making cuts to Medicare.
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Editor's Note: Mr. Gephardt represents clients in the healthcare sector. A list of his clients can be found here.

The Affordable Care Act (ACA) was a major accomplishment that will improve both our health care and our health insurance systems. The provisions to cover millions of uninsured Americans, end the practice of denying coverage for pre-existing conditions, institute delivery system reforms, and promote medical innovation deserve the support of all Americans.

As we all know, there is rarely such a thing as "perfect" legislation. President Obama recently signed into law the first significant improvement to the ACA: the repeal of the "1099 mandate" which Democrats and Republicans agreed would have placed an unnecessary burden on small businesses.

I have no doubt that the American people will stand firmly against efforts to undermine the law in its entirety, but as is the case with any legislation, there is room for improvement. I believe there is a step that's needed to continue to protect beneficiaries' access to Medicare services: the elimination of the Independent Payment Advisory Board (IPAB). Under the new law IPAB has been made responsible for suggesting and implementing cuts to Medicare. It is critical that Congress continue to be able to fulfill its duty to the American people and maintain direct oversight of Medicare on behalf of their constituents. Changes to Medicare's payments should be based on careful consideration of the Medicare program itself -- and not arbitrary budget targets.

Under the current law, IPAB will be an unelected and unaccountable group whose sole charge is to reduce Medicare spending based on an arbitrary target growth rate. It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar. Just as important, these cuts 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. Certainly Medicare must be viable for current and future generations of seniors, but it would be wrong to achieve this goal by denying Medicare beneficiaries access to comprehensive and high quality health care.

The damage from large and arbitrary cuts to Medicare payments will likely extend beyond Medicare itself. Since 1965, Medicare has served as the baseline for health-care spending in the United States. There is the very real risk that private sector insurance payments will follow Medicare payments' downward trend until the under-65 population also loses access to care. The far-reaching impact of any of these consequences on Americans of all ages is so alarming that thorough, open Congressional evaluation and debate are essential.

In addition to threatening access, IPAB will negate the provisions in ACA that would otherwise improve health care delivery. These provisions include a heightened emphasis on preventive services and the incentives to coordinate delivery models that are designed to ensure that patients receive the right services they need, in the right quantity, and at the right time. Also of great concern to me is the possibility that untenably low payments will have a chilling effect on the research and development necessary to spur what promises to be the next great breakthrough in prescription drug treatment: personalized medicine, which would treat with pharmaceuticals and biologics tailored to an individual's genetic make-up. These are the very steps needed to lower Medicare spending in meaningful and sustainable ways, helping Medicare beneficiaries, the under-65 population, and our economy.

Democrats and Republicans have an opportunity to embrace bi-partisan legislation eliminating IPAB, thus giving direct oversight of Medicare back to Congress, and giving the policy-based payment reforms in the ACA a chance to work. This is the way to ensure continued access to care and lay the groundwork for the next phase of reform.

Members of Congress are elected to do their constituents' business and protect their interests. Serving as the stewards of Medicare is an important part of Congress' responsibilities. Representative democracy might not function as quickly as might be hoped and it certainly is not perfect. But creating an unaccountable board of unelected individuals, even if they are experts, to impose their will on the American people is far worse.

Former Rep. Dick Gephardt of Missouri served as a House Democratic leader. He is now president and chief executive officer of Gephardt Government Affairs.

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