Seniors should be especially concerned about a provision of last year’s health care overhaul that would create a panel of unelected federal bureaucrats to oversee Medicare costs: the Independent Payment Advisory Board, or IPAB.
Here’s how it works: The president selects 15 health care experts and tasks them with finding ways to keep Medicare’s total spending from rising beyond certain targets.
The board then proposes changes to the program each year Medicare is projected to cost more than the targeted amount.
If Congress does nothing, they become law automatically. The only way Congress can stop the changes is by passing a package of equally large cuts or with a three-fifths override vote in the Senate — an extremely high bar.
The result is that a small board of unelected bureaucrats has a surprising degree of control over the entire system.
Duly elected members of Congress whose job it is to look out for their constituents’ interests, meanwhile, have relatively little influence over the board’s decisions.
Don’t like it? Too bad: IPAB’s recommendations are not subject to judicial review, either.
IPAB’s only limits come from rules about how it’s allowed to keep Medicare’s costs in line.
Among other restrictions, it’s not allowed to bring in more tax revenue, and hospitals are exempt from cuts until 2019.
All told, IPAB is limited to essentially one avenue for savings: arbitrary payment cuts and eliminating the most cost-effective providers, such as doctors and mental health professionals for seniors’ services.
For the 1.2 million people in Georgia who rely on Medicare, that’s a problem: Cutting out health providers and cutting doctors’ Medicare pay means cutting seniors’ Medicare access.
A third of the state’s counties have been recognized as short on primary care physicians — and specialists are getting harder to find as well. Georgia already ranks a dismal 39th among U.S. states in terms of doctors per capita, and if IPAB cuts reimbursement rates, it’s likely to make the situation worse.
In late 2010 the president of the Georgia Academy of Family Physicians warned that if big Medicare reimbursement cuts came down the line, 10 percent of family practices would be forced to shut down.
At this time, mental health professionals, licensed professional counselors, are still not included in Medicare, leaving mental health and physical health on a downward spiral.
Georgia’s seniors are understandably concerned about the state of health access already. In a November 2010 survey, 83 percent of the state’s AARP members said they were worried that they wouldn’t be able to find a new doctor if their current physician stopped accepting Medicare.
In this fiscal climate, they have good reason to be worried, and IPAB will only make it worse.
Gale Macke is the executive director of the Licensed Professional Counselors Association of Georgia.
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