IPAB will affect Medicare

Published 12:00 am Saturday, June 8, 2013

In light of the recent passage of Medicaid reform by the Alabama Legislature, and the ongoing conversation surrounding Medicare budget negotiations in Washington, I am writing to register two remarks.

First, I would like to congratulate the Legislature for taking an important step forward in the effort to improve the delivery of services and curb the escalating costs of health care in this state.

Second, while looking at the example of Alabama expanding services while cutting costs, I am compelled to vocalize my concern that the federal government is mistaken in its belief that the Independent Payment Advisory Board, or IPAB as it is known, will be a credible means to save money in Medicare while continuing the delivery of services to American seniors.

The IPAB, a 15-member board appointed by the president, was designed by the Obama administration to reduce costs in the Medicare system by capping expenses, and cutting payments to doctors or other health providers. For the record, Medicare is for individuals who are 65 years and older, or who qualify with a disability.

While I believe the IPAB approach has numerous flaws, which I will explain, one of the most glaring is the notion that cutting payments to doctors will result in better delivery of services for reduced costs.

According to most experts, cutting payments and reimbursements to health providers will only place further strain on our doctors, which will in turn result in reduced services for patients.

Ask any business owner what would happen if they were to stop getting paid for their services, and the answer will be that the business owner would go out of business. Why would the president think the result would be any different if we were to stop paying doctors who see Medicare recipients?

If the IPAB is allowed to cuts payments, the result will be that the few physicians who still see Medicare patients will either stop accepting these patients, or be forced to cut back services. In a situation where a particular doctor’s primary clientele are Medicare recipients, said doctor may be forced to go out of business.

It’s hard to increase the delivery of services if you can’t keep the lights on.

Another glowing mistake with the IPAB is that it was designed as an independent board accountable to the president – not Congress. Therefore, it will theoretically have the power to reverse laws enacted by our elected representatives and the person with the ultimate authority to change the makeup of the board is the president.

How can the idea of creating a new short arm of the government that is accountable to one person, and whose sole purpose is to restrict services by cutting payments to doctors be considered in any way, shape or form part of the solution for Medicare?

As the former director of the Alabama Ethics Commission, and current Speaker of the Alabama Silver Haired Legislature, I am pleased to see the progress made as it relates to the delivery of services for Medicaid beneficiaries in my own state. However, I also recognize that in many parts of Alabama we have a shortage of health providers. The last thing we need is for the federal government to create a new unaccountable board of “experts” whose sole purpose is to ration care and open the doors to restrictions on health services for senior citizens and the disabled.

Fortunately, for any readers who share my concern, it may be comforting to know we are not alone. More than 500 state and national organizations recently circulated a letter advocating for the repeal of IPAB.

As important as Medicaid is to the funding and delivery of healthcare in Alabama, Medicare is tremendously important to the solvency of our nation’s overall health system. I encourage everyone to express your concern for IPAB and hope that our elected officials will work together to continue improving our health system in commonsense and transparent ways that do not jeopardize the delivery of and access to services.



Respectfully submitted,

Melvin Cooper

Speaker, Alabama Silver Haired Legislature