Sav­ing money but cost­ing lives

The Oba­macare death panel should be killed be­fore it’s too late

The Washington Times Daily - - COMMENTARY - By Peter J. Ferrara Peter J. Ferrara is a se­nior fel­low at the Heart­land In­sti­tute, and served in the Rea­gan and Ge­orge H.W. Bush ad­min­is­tra­tions.

Buried deep within Oba­macare is a pro­vi­sion that takes away health care from you and your doc­tors, by tak­ing away pay­ment for crit­i­cal health care that may be needed to save your life. It is called The In­de­pen­dent Pay­ment Ad­vi­sory Board (IPAB).

The board will be in­de­pen­dent of you, your doc­tors, your hos­pi­tals, Medi­care, Con­gress, the ju­di­ciary, the demo­cratic process, ul­ti­mately even the Con­sti­tu­tion it­self. As the Cato In­sti­tute tried to warn us five years ago, IPAB is “in­de­pen­dent in the worst sense of the word: in­de­pen­dent of Con­gress, in­de­pen­dent of the pres­i­dent, in­de­pen­dent of the ju­di­ciary, and in­de­pen­dent of the will of the peo­ple.”

IPAB is to be com­posed of 15 un­elected bu­reau­crats ap­pointed by the pres­i­dent and con­firmed by the Se­nate. But the board and its pow­ers are so dan­ger­ous that even Pres­i­dent Obama never made any ap­point­ments.

Start­ing next year, if Medi­care spend­ing is pro­jected to grow faster than the rate of eco­nomic growth per capita plus 1 per­cent­age point, IPAB is em­pow­ered to make a pro­posal that will cut Medi­care spend­ing at least to the tar­geted growth rate. IPAB will be propos­ing such Medi­care cuts ev­ery year start­ing next year be­cause his­tor­i­cally, Medi­care spend­ing has grown ev­ery year by per capita eco­nomic growth plus 2.6 per­cent­age points.

Oba­macare, how­ever, ex­pressly ex­cluded IPAB from achiev­ing the re­quired sav­ings by ra­tioning health care, rais­ing taxes, in­creas­ing cost­shar­ing in Medi­care, cut­ting Medi­care ben­e­fits, or al­ter­ing Medi­care el­i­gi­bil­ity. That leaves IPAB with just 2 op­tions — slash pay­ments to doc­tors, hos­pi­tals and other health care providers un­der Medi­care, or deny spe­cific health care treat­ments to se­niors on grounds they are not “cost ef­fec­tive,” as the Bri­tish Na­tional Health Ser­vice does for so­cial­ized medicine, so ad­mired by Democrats.

Both of which add up to ra­tioning af­ter all. Over­all, Oba­macare cut more than

$700 bil­lion from Medi­care, al­most all com­ing out of pay­ments to doc­tors and hos­pi­tals for health care for se­niors. But if doc­tors and hos­pi­tals are not go­ing to be paid their fees, se­niors will not be get­ting the health care they ex­pect un­der Medi­care.

The chief ac­tu­ary for Medi­care re­ports that ul­ti­mately un­der Oba­macare, Medi­care pay­ment rates will be only one third of what will be paid by pri­vate in­surance and only half of what is paid by Med­i­caid, in which the poor of­ten can’t find ac­cess to essen­tial care. The ac­tu­ar­ies ex­plain that the Oba­macare Medi­care cuts would re­sult in “neg­a­tive to­tal fa­cil­ity mar­gins” for about 40 per­cent of hos­pi­tals, skilled nurs­ing fa­cil­i­ties, and home health agen­cies by 2050.

The ac­tu­ar­ies add, “In prac­tice, providers could not sus­tain con­tin­u­ing neg­a­tive [losses] and, ab­sent leg­isla­tive changes, would have to with­draw from pro­vid­ing ser­vices to Medi­care ben­e­fi­cia­ries.” Ti­mothy Jost writes in the New Eng­land Jour­nal of Medicine, “If the gap be­tween pri­vate and Medi­care rates con­tin­ues to grow, health care providers may well aban­don Medi­care.”

Un­der Oba­macare, when IPAB pro­poses these Medi­care cuts, they au­to­mat­i­cally be­come law, un­less Con­gress passes and the pres­i­dent signs al­ter­na­tive cuts of the same amount. Oba­macare re­quires the sec­re­tary of health and hu­man ser­vices to im­ple­ment the IPAB cuts oth­er­wise.

More­over, Oba­macare em­pow­ers the board to pro­pose these Medi­care cuts even with just one mem­ber of the board ap­pointed. If no one is ever ap­pointed, Oba­macare re­quires the sec­re­tary of health and hu­man ser­vices to make the re­quired Medi­care cuts ev­ery year.

But Oba­macare does not limit IPAB to cut­ting Medi­care. Oba­macare au­tho­rizes IPAB to make cuts “to slow the growth in na­tional health ex­pen­di­tures” and “Non-Fed­eral Health Care Pro­grams.” In­deed, with IPAB’s Medi­care cuts, those broader cuts to na­tional health care spend­ing and doc­tors and hos­pi­tals will be nec­es­sary “to main­tain­ing or en­hanc­ing ben­e­fi­ciary ac­cess to qual­ity care un­der [Medi­care].”

Oba­macare fur­ther pro­vides that noth­ing that the board does can be chal­lenged or re­viewed in any court, fed­eral or state. Oba­macare even pur­ports to re­strict Con­gress’ power to re­peal IPAB.

Oba­macare specif­i­cally states that Con­gress can only re­peal IPAB through a pre­cisely worded joint res­o­lu­tion in­tro­duced in both houses of Con­gress in Jan­uary 2017, which Repub­li­cans have al­ready in­tro­duced. Oba­macare fur­ther pro­vides that re­peal can only be en­acted by a three-fifths su­per­ma­jor­ity in both houses, by Aug. 15. Oth­er­wise, Oba­macare states Con­gress may never, ever re­peal IPAB af­ter­ward.

IPAB re­flects a Hugo Chavez-style so­cial­ist dic­ta­tor­ship that threat­ens the very lives of the Amer­i­can peo­ple, by deny­ing them health care when they most need it. We must get rid of it now, be­fore it is too late.

Oba­macare pro­vides that noth­ing that the board does can be chal­lenged or re­viewed in any court, fed­eral or state.


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