The Right Way to Preserve Medicare Doesn't Limit Access to Care
Roger Stark, MD, FACS, Health Care Policy Analyst, May, 2012
The Seattle Times published this column on April 23, 2012.
Nearly 1 million Washington residents, 14 percent of our state's population, rely on Medicare for health coverage each year. It should go without saying that the long-term fiscal health of the program is crucial for our seniors.
Yet Medicare is headed toward bankruptcy. Here in Washington, Medicare expenditures have increased by 8.2 percent per year on average over the past two decades. That's more than double the rate of inflation and unsustainable over the long run.
But there are right ways and wrong ways to bring Medicare costs into line. Unfortunately, one part of the 2010 health-reform legislation is a big step in the wrong direction, one that could cost seniors in Washington and nationwide access to the care they need.
The Affordable Care Act established a new government body called the Independent Payment Advisory Board (IPAB), which is empowered to make major policy changes to the Medicare program to generate savings.
IPAB's membership consists of 15 presidential appointees. Beginning in 2014, the Centers of Medicare and Medicaid Services will set an annual growth target for Medicare. If the program exceeds that target, IPAB is empowered to design cost-cutting measures to get the program back on track.
In reality, there's very little Congress can do to stop IPAB's "recommendations" from becoming law. They automatically take effect unless Congress musters a two-thirds supermajority vote to overturn them, or passes entirely new legislation that achieves the same level of cost savings.
To combat excessive Medicare cost increases, IPAB is authorized to cut up to 0.5 percent of Medicare spending in its first year and up to 1.5 percent in following years. These cuts would be on top of an already scheduled $500 billion cut in Medicare funding.
IPAB's policymaking tools are very limited. It is prohibited from making any structural reforms to the Medicare program. It can't alter the program's fee-for-service system or eligibility rules.
The chief cost-cutting tool left to IPAB is reducing reimbursement rates for doctors and other health-care providers participating in Medicare.
And that is exactly the problem. These rates are already so low that many doctors are simply refusing to treat Medicare patients. One survey from the American Medical Association found that 17 percent of all doctors, including 31 percent of primary-care physicians, have restricted the number of Medicare patients in their practices because of low reimbursements. Some have stopped taking Medicare patients altogether.
As a result, in many parts of the country, seniors have a hard time finding someone to treat them. Technically, they are "insured." But they don't have access to a physician. They get stuck in long waiting lines. And their conditions get worse.
IPAB's cuts will certainly exacerbate the Medicare doctor-shortage crisis. If rates go lower, there could be a mass exodus of health-care providers from Medicare. And seniors would have an even harder time finding someone to treat them.
For the sake of our seniors, Congress must repeal IPAB and ensure Medicare enrollees continue to get the quality care they deserve.
Fortunately, one of our federal representatives, Rep. Cathy McMorris Rodgers, R-Spokane, recently threw her support behind a bill that would repeal IPAB. As she has put it, IPAB's cost-cutting will result in "even fewer doctors, decreased access, and a lower quality of care" for Washington's Medicare population. A key House subcommittee has just approved repeal legislation that has more than 200 co-sponsors from both sides of the aisle.
Patient groups and doctors are beginning to catch on to just how dangerous IPAB is to seniors' health. Some 250 health-care groups recently signed a letter to Congress urging repeal. This list included our own Washington State Medical Association and the Washington State Urology Society.
Medicare must be reformed, but not at the expense of seniors' access to care. Lawmakers, both here in Washington and across the country, must act now to repeal IPAB and protect beneficiaries.