If you are insured through Medicare, should you be worried about the Affordable Care Act? I am and for two reasons. The first is a committee called the Patient-Centered Outcomes Research Institute. Their job is to compare various medical treatments of ailments and their outcomes. By studying different methods of treating the same ailment, weighed against the cost and outcome, they must recommend the most cost-effective. A board will take the findings of this group and make non-binding recommendations about treating Medicare patients.
The second is a group of 15 appointed individuals called the Independent Payment Advisory Board (IPAB). Their recommendations, based on findings from the research institute, become part of the law in 2018 unless overruled by three-fifths of Congress. The purpose of these two groups is to find ways to cut $500 to $750 billion out of Medicare spending by 2020 to help pay for the increased cost of insurance subsidies the law allows people whose income is up to 400 percent of the federal poverty level and the increased costs of Medicaid.
IPAB cannot recommend rationing care, changing benefits or raising premiums, so what can they do? Just what their name implies — control payments. Their job is to decide how much physicians and patient-care providers can be paid for certain procedures. For example, because of a genetic eye disease, I have had four cornea transplants. For simplification, I will say each surgical procedure was a “partial transplant,” a less complicated surgery. A full transplant takes longer to perform and longer to heal but is the best option in some cases. IPAB could say that a full transplant is not cost-effective and the reimbursement rate will be the same for both procedures. Surgeons would lose money by performing full transplants. Translate that scenario to complicated heart surgeries or cancer treatments. Health care by actuarial edict — a backdoor way to ration care.
The law stipulates that research from those two groups cannot be used to treat elderly, disabled or terminally ill Medicare patients “as lower in value” than those who are “younger, non-disabled or not terminally ill.” Unfortunately, the next paragraph states that the Health and Human Services secretary can limit “alternative treatments” of the elderly if they are not recommended by the researchers.
The Department of Health and Human Services is still churning out thousands of pages of rules about the implementation of Obamacare. This president’s signature achievement is not “settled law.” It’s a snowballing disaster.
Ina Fay Manly