Capitol Words a project of the Sunlight Foundation

  • and

Protecting Access To Healthcare Act

Rep. Joe Courtney

legislator photo

Mr. Chair, since 1965, Medicare has provided seniors guaranteed health benefits and today, close to 50 million Americans who have paid into the system now rely on the program for care. While the program's sustainability is stronger than in recent past, this Congress, like those before it, has an obligation to ensure sustainability of the program for current enrollees and future beneficiaries. The Independent Payment Advisory Board, IPAB, was created with this objective in mind. However, despite best intentions, I believe that IPAB is the wrong approach to achieve this shared goal.

Relinquishing control of Medicare provider reimbursements to an unelected IPAB is problematic to me for a number of reasons. Congress has helped shape a Medicare system that reflects unique care needs of varying demographics as well as differences between regions and states. Further, this system has been developed with transparency and accountability in congressional debates. Implementing IPAB would limit the strengths of the current system, and would continue a trend of ceding congressional authority to the Executive branch. This is, in part, why I cosponsored the Medicare Decisions Accountability Act, H.R. 452, legislation to repeal IPAB.

The fact is that the Affordable Care Act will contain spending growth in the Medicare program--independent of proposed IPAB reforms--through integrated and coordinated care models and modest reimbursement changes. The Congressional Budget Office, CBO, estimates that the law will slow annual Medicare growth from seven to four percent over the next decade. And, over the past year, the S&P has measured the lowest rate of growth in the history of Medicare--below three percent.

Today, the House considered legislation to repeal IPAB, a goal that I support. Unfortunately, a calculated choice to polarize the vote by incorporating the HEALTH Act (H.R. 5)--an unrelated and divisive bill--emphasizes the cynical gamesmanship of Republican leadership who clearly are not interested in forging a partisan coalition to repeal IPAB. The HEALTH Act, in part, limits intentional torts or cases where harm is deliberate. A recent case in Connecticut, which involved victims of sexual assault, underscores the harm in these restrictions. Under H.R. 5, these victims would be denied their day in court.

Over the next ten years, Medicare will cost between $8 trillion and $9 trillion and there are a whole host of offsets which would easily counter the costs of IPAB repeal without injecting scorched earth partisan politics. For example, MedPAC has recommended rescinding duplicative bonus payments to private insurance providers that administer Medicare Advantage plans, which have historically been overpaid by 14 percent. At the very least, this option provides a more tempered approach to offset H.R. 452 and build an honest consensus on repealing IPAB.

Despite my long-standing support for the repeal of IPAB, I cannot support H.R. 5 as presented to the House today. It is my sincere hope that this chamber can debate the repeal of IPAB through a more measured, balanced, and reasonable approach in the future.