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Honorable Mark Sanford

Representing the 1st District of South Carolina

Vote Notes: Protecting Seniors’ Access to Medicare Act of 2017

Dec 28, 2017
Blog Post

Do you remember the death panels that Sarah Palin used to talk about?

Well, they’re still around...and we took a vote just last month to go ahead and put them to death, given practical and constitutional grounds that warranted doing so.

Indeed, the House passed legislation to repeal the Independent Payment Advisory Board (IPAB) by a vote of 307 to 111. I voted yes on the bill.

Here was my reasoning….

IPAB was created under the Affordable Care Act (ACA) to control Medicare costs. It allowed the board or the Secretary of Health and Human Services (HHS) to cut reimbursement payments for doctors and hospitals and to restrict benefits...without congressional approval. My main concerns with IPAB and the reasons I voted to repeal it were twofold. First, it was an improper delegation of authority to unelected bureaucrats. Second, the potential cuts could have hurt seniors by inadvertently rationing their health care.

With respect to the improper delegation of authority…our government is said to be “of the people, by the people, and for the people.” Indeed, Article I of the Constitution vests all legislative powers in Congress. Yet, under the ACA, a board of unelected bureaucrats was empowered to make changes to Medicare without direction from Congress. That is not the way our republican system of government is supposed to work. Rather, it is the people’s representatives in Congress that are meant to give them a voice and allow them to participate in the many policy decisions that impact them. This is even more obviously the case when it comes to major programs, such as Medicare.

Currently, Medicare provides health insurance to more than 57 million people. In 2016, spending for this one program made up 15 percent of the total federal budget, and that is projected to rise to 17.5 percent by 2027. Medicare is the third largest federal program behind defense and Social Security. It seems to me that both the Constitution and basic issues of fairness require congressional approval for any changes to this program.

As to the second matter, cuts to physicians and hospitals may have resulted in rationed health care for seniors. This is because lower reimbursement rates could push doctors out of the program, as it makes less and less economic sense to keep seeing Medicare patients. That would  leave seniors with fewer health care options. Fewer providers could also mean seniors are not able to see their doctor when they need to. The board also had authority to pick and choose and deny treatments and medical services. Additionally, the IPAB process for determining when cuts would be made could have required significant cuts over a single year; that kind of abrupt change would be difficult for providers and their patients. All of this adds up to being counterproductive for getting seniors access to affordable health care.

Medicare is already under financial pressure, largely due to demographic factors and general rising health care costs. As baby-boomers continue to age, Medicare’s eligible population will double. The Trustees report from July indicates that the Hospital Insurance Trust Fund, which finances inpatient hospital coverage, will be fully depleted in 2029, this is only 12 years from now. If that happens, Medicare will not be able to pay 12 percent of what it owes. I believe Congress needs to address these sustainability issues sooner rather than later, because the longer these financial issues go unaddressed, the harder the choices are going to become. It is likely to mean some combination of benefit cuts, eligibility changes, cost-sharing increases, reductions to provider payments, and/or tax increases. Payroll taxes under the Federal Insurance Contributions Act (FICA), which fund Social Security and part of Medicare and which both employer and employee pay a part, are already 15.3 percent for those who make under $200,000 a year. So the point here is decisions that are tough now will only get tougher the longer Congress waits to act.

So, the bottomline is I believe Congress should address Medicare’s financial sustainability. The reasoning behind IPAB was legitimate in that regard, but the way in which it attempted to address the issue would come at a real cost to seniors in need of healthcare and the balance of power as outlined in the separation of powers by the Founding Fathers.