This Unelected Board Would Have Put Seniors’ Health Care at Risk. Now, It’s On the Chopping Block.

COMMENTARY Health Care Reform

This Unelected Board Would Have Put Seniors’ Health Care at Risk. Now, It’s On the Chopping Block.

Oct 17th, 2017 3 min read

Commentary By

Jean Morrow

Former Research Assistant, Domestic Policy Studies

Robert E. Moffit, Ph.D.

Senior Fellow

A bill to repeal the Independent Payment Advisory Board received support from 221 Republicans and 43 Democrats. iStock

Key Takeaways

Finding bipartisan agreement on any issue today is rare, and on health reform, essentially non-existent.

The bipartisan concern is that Medicare policy should not be left to 15 unelected, unaccountable bureaucrats.

Once IPAB has been scrapped, the road to Medicare reform will be wide open.

Finding bipartisan agreement on any issue today is rare, and on health reform, essentially non-existent. So what’s getting both Democrats and Republicans on the same wavelength?

Four words: Independent Payment Advisory Board.

This board, also known as IPAB, doesn’t quite exist yet. Under Obamacare, it was meant to be a powerful bureaucratic body of 15 unelected officials appointed by the president and confirmed by the Senate.

It’s job? Recommend ways to cut spending on Medicare—the program that provides health care to millions of American seniors. Specifically, it would have to recommend cuts in order to meet Obamacare’s budget targets, but without doing any harm to seniors. A tough task.

But while it was supposed to issue its first order recommendation in 2014, the board hasn’t even been assembled yet. President Barack Obama never appointed members to sit on the board, and President Donald Trump hasn’t appointed any, either.

But the board continues to exist on the books of Obamacare, and that’s of concern to Republicans—and, it seems, some Democrats.

Reps. Phil Roe, R-Tenn., and Raul Ruiz, D-Calif., have introduced a bill that would repeal IPAB, and recently, the House Ways and Means Committee approved it. The bill has support from 43 Democrats and 221 Republicans.

The bipartisan concern is that Medicare policy should not be left to 15 unelected, unaccountable bureaucrats. Health policy analysts have long warned about these dangers, and members of both parties are responding.

To be clear, the board’s powers under Obamacare would be constrained. The board cannot make changes to cost-sharing rules, payment models, benefit offerings, or any structural reforms to the Medicare program. Its job is simply to make recommended spending cuts.

But turning this task over to 15 bureaucrats who can make arbitrary decisions about payment cuts to different medical treatments and procedures is unwise. That kind of concentrated power in the hands of unelected bureaucrats is just too much for a free society.

Moreover, IPAB would not be able to accomplish the kinds of deep structural reforms that Medicare needs. That is a job for Congress.

Medicare is a 50-year-old program that needs real reform, and that means having a heavy dose of market competition injected into it. It is these reforms, not arbitrary spending cuts from IPAB that will get Medicare costs under control.

Spending cuts from IPAB could also be counterproductive for seniors. They could actually jeopardize seniors’ access to care, and, as Heritage analysts and others have argued, push even more physicians out of the program.

After repealing IPAB, Congress should get to work on Medicare reform at the structural level.

The best course is to move to a flexible, market-driven premium support model. This would put patients in the driver’s seat, allowing them to choose the plan that best meets their needs, whether that be the traditional Medicare plan, an employer plan, or a private health plan.

Here, just as with the Medicare prescription drug program, the government would help cover the cost of a plan that the Medicare beneficiary chooses.

Real Medicare reform would empower patients, not bureaucrats. It would not only protect seniors’ access to quality care, but also expand personal choice and foster intense competition among Medicare plans and providers. That’s the right way to control costs.

This is all achievable. Once IPAB has been scrapped, the road to Medicare reform will be wide open. Congress should take the next steps in getting rid of IPAB—and we should all take heart that for once, bipartisan action is working.

This piece originally appeared in The Daily Signal

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