Editorial: Stop playing games with Obamacare

  • Updated: November 16, 2012 - 6:03 PM

Repealing Medicare board shouldn't be a top priority.

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Thirty-three. That's the number of times that the Republican-controlled U.S. House voted to repeal, weaken or defund the Affordable Care Act -- votes that were purely symbolic because Democrats controlled the White House and the U.S. Senate.

It's long past time for this tired political theater to end. Voters and the U.S. Supreme Court have weighed in. The Affordable Care Act is the law of the land. More anti-Obamacare votes equal more time wasted on the taxpayers' tab. More importantly, it's a distraction from the critical work that lies ahead to avert the "fiscal cliff," solidify a still-fragile economy and grapple with vexing foreign-policy challenges.

Unfortunately, at least one more meaningless anti-Obamacare vote likely looms. On Nov. 7, the day after President Obama scored a decisive victory and Democrats expanded their majority in the Senate, House Majority Leader Eric Cantor sent his caucus a letter outlining legislative priorities. There were some admirable goals, including immigration reform and improving the regulatory climate for life-science industries.

But Cantor's list also wrongheadedly took aim at the ACA yet again. The goal: repealing a key cost-control backstop within the law called the Independent Payment Advisory Board (IPAB).

Few other components of the landmark health overhaul have been subject to such blatant fear-mongering. The board's mostly Republican critics -- including Mitt Romney, Paul Ryan and singer Pat Boone, a recent spokesman for a conservative group targeting seniors -- have contended that the board will dictate treatments or deny care to senior citizens. The PolitiFact fact-checking website has given such claims a strong thumbs-down.

The reality is that the ACA places strict limits on the board. Its mission is to find ways to rein in the cost of Medicare -- the federal health care program for seniors -- and make recommendations to Congress that lawmakers can accept or reject if other cost-saving measures are found.

But the board's 15 members -- chosen by the president and confirmed by the Senate --are specifically barred by law from rationing care. They also can't raise taxes or increase enrollees' premiums or cost-sharing. Nor can Medicare eligibility be modified.

What the board can do is reduce payments to providers, though certain ones are off-limits for a time. While critics raise fair concerns that blunt cuts could cause some providers to opt out of Medicare, the board can also focus more smartly on payment reform that rewards providers for value rather than volume. An advantage of having the board make these painful cost-cutting decisions is that the process would be public, with elected officials able to override decisions if they choose.

There are only so many ways to reduce Medicare spending. Republican calls for privatizing Medicare, if enacted, would still allow for payment reform or provider cuts. But a decisionmaking process driven by insurers would not offer the same level of transparency or accountability.

It's unclear why repealing the board is such a high priority this session. The board only has to make recommendations if Medicare spending growth targets are exceeded -- something that federal officials now say isn't likely to happen until 2022 at the soonest.

Obama needs to be more forthcoming about who will serve on the board, and he needs to ensure that the "don't touch entitlements" wing of his own party doesn't derail its implementation. Cantor, whose office declined comment, needs to focus on more productive issues. The IPAB may not need to go to work immediately, but it's an important cost-control mechanism to have in reserve if the nations' political leaders fail to find other ways to rein in Medicare costs.

  • TO LEARN MORE

    The respected Kaiser Family Foundation has an excellent backgrounder on the Independent Payment Advisory Board. To read it, go to tinyurl.com/6bp7t2m

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