10/6/17 Paulsen Correspondence Corner : Killing the IPAB

PREFACE :
Erik Paulsen regularly issues a video Correspondence Corner in which he responds to constituent questions.
It is a great ploy — Congressman Paulsen determines what question is to be answered … thus, providing him an opportunity to portray himself as effectively responding to issues that he wishes to address as if they are the most critical issues that voters want addressed.
The MN Political Roundtable will be evaluating Congressman Paulsen’s responses and encouraging readers to offer their own assessments.

Yesterday’s topic: H.R.1468 – Recognizing America’s Children Act.

Today’s topic: H.R. 849 – Protecting Seniors’ Access to Medicare Act of 2017

Before viewing the second subject of this week’s Paulsen Correspondence Corner, let’s recall the warning expressed by Senator Lindsey Graham during the CNN Cassidy-Graham-Klobuchar-Sanders Town Hall event ….
GRAHAM: Medicare, Medicaid, interest on the debt are going to consume all the money you send in taxes by 2040. If we don’t turn this around now, we’re going to leave a country that’s completely and utterly bankrupt. Can you control the cost of Medicaid and still be humane? I think you can, and you better, because Medicare and Medicaid are on the path to just collapse.
GRAHAM: All I would say is that Medicare is coming unraveled. By 2038, the trust fund is going to run out of money.
GRAHAM: Let’s talk about $20 trillion of debt. Let’s talk about Medicaid. Medicaid, Medicare, Social Security, and interest on the debt is going to consume all the money you send in the future in taxes. Do you care about the debt?
GRAHAM: All I can say is, if you do nothing, if we just play like nothing’s going to change unless somebody makes it change
GRAHAM: I’d just end with this. We’re going to go one of two ways in this country. We’re going to create a future for our children that they can actually afford. We’re going to deal with a $20 trillion debt or we’re going to pass it on to somebody else. And driving the debt is Medicare, Medicaid, Social Security, and interest on the debt. Somebody needs to deal with this.

OK … here is a Republican Senator worried about the debt and warning that we need to address Medicare spending.

OK …. watch “Representative” Paulsen respond to Mark of Minnetonka who represents the “specialty medicine community” advocating for H.R.849 – Protecting Seniors’ Access to Medicare Act of 2017


Gosh … doesn’t Protecting Seniors’ Access to Medicare Act of 2017 sound like a great bill title ? ? ? ?

No wonder it has 245 Republican sponsors (along with 44 Democrats) …. so it is bipartisan … yet, when it was approved in the Ways and Means Committee, the vote was 24-13 (that being all Republicans who voted plus two Democrats as YES votes and all the NO votes from Democrats.) Well, not quite as bipartisan as being presented.

So, what does the bill do ?
Well, it kills the IPAB — Independent Payment Advisory Board.

What is the IPAB ?
Well, it doesn’t exist … unless you believe in the boogeyman and Death Panels.
It could exist … but the HHS and CMS report that current Medicare spending is less than the Medicare per capita target growth rate –

The projected 5-year average growth in Medicare per capita spending is 2.14 percent, and the 5-year average growth target is 2.87 percent

As such, the IPAB which would then be required to make “recommendations that would reduce overall Medicare spending by the applicable percent determined by the CMS actuary”, is not necessary.
And the non-existent IPAB has not been necessary since it was established as part of the Affordable Care Act as a trigger to address potential rising costs. In fact, the targets have not been exceeded since the provision was established for 2013 … (makes you gotta say that despite the boogeyman fear-mongering, ObamaCare is working. After all, the Medicare trust fund, which finances the program’s hospital insurance, will remain fully funded until 2029. This is 11 years longer than was projected in 2009, before the passage of ObamaCare.)

Simply stated, the necessary conditions to trigger IPAB activity have not yet been met.

OK, but what if the targets had been reached ?
Generally, proposals made pursuant to the IPAB statutory authority are limited to Medicare policies that do not ration health care, raise revenues or Medicare beneficiary premiums, increase Medicare beneficiary cost-sharing, or otherwise restrict benefits or modify eligibility criteria.

OK … so (besides the fact that the IPAB was a component of ObamaCare) why should it be killed ?
Well, to listen to Congressman Paulsen, that is because the IPAB is “an unelected, unaccountable panel of bureaucrats” … OK … the unelected part is true … as the members of the IPAB must be nominated by the President

In selecting individuals for nominations for appointments to the Board, the President shall consult with:
(i) the majority leader of the Senate concerning the appointment of 3 members;
(ii) the Speaker of the House of Representatives concerning the appointment of 3 members;
(iii) the minority leader of the Senate concerning the appointment of 3 members;
and (iv) the minority leader of the House of Representatives concerning the appointment of 3 members.

Considering Betsy DeVos at Education and Ben Carson at HUD, Congressman Paulsen should be concerned about unqualified bureaucrats running our government … but the “unaccountable” part is questionable … the IPAB makes recommendations, it is up to Congress (through the House Ways and Means Committee where Congressman Paulsen is assigned) to accept or find alternatives.

Upon receipt of the IPAB recommendations, Congress would until April 1 of the proposal year to report legislation that approves the proposal or alternative legislation that modifies the proposal but achieves the same level of savings.

What Congressman Paulsen doesn’t say is that if the IPAB was needed, it would recommend solutions and force Congress to act … instead we hear Senator Graham and Congressman Paulsen have better ideas … ideas that have been rejected by the American Association of Retired Persons, American Medical Association, the American Hospital Association, the American Cancer Society, the Alzheimer’s Society, and virtually every single major medical organization in this country.

Congressman Paulsen is once again misinforming his constituents, hiding behind creatively named bills and embracing “death panel” fears, all the while professing a persona that is concerned with the national debt.

Yet to address the national debt, Congressman Paulsen just voted for the Republican budget which AARP has informed seniors

The House of Representatives passed a budget on Thursday that would cut Medicare by $487 billion over the next decade, recommends raising the eligibility age and opens the door to transforming the health insurance plan into a voucher program.

The measure passed by 219-206 vote with all Democrats and 18 Republicans voting no.

In addition to the Medicare spending cut, the proposal recommends raising the Medicare eligibility age from 65 to 67 and suggests instituting defined contributions for the program for new beneficiaries. Under such a plan, each beneficiary would get a set amount of money to pay for health costs.

“These proposals do little to actually lower the cost of health care, but simply shift costs from Medicare onto individuals — many of whom cannot afford to pay more for their care,” AARP Chief Executive Officer Jo Ann Jenkins said Tuesday in a letter to members of Congress. According to AARP, the typical senior has an annual income of less than $25,000 and already spends 1 out of every 6 dollars of that income on health care.

The House measure additionally would slash Medicaid and other health programs by $1.5 trillion over 10 years. Medicaid helps pay for health care and long-term care services for 17 million poor elderly, children and adults with disabilities.

The budget also cuts the Supplemental Nutrition Assistance Program (SNAP), better known as the food stamp program, which helps feed millions of Americans, including 4 million older adults.

Instead of addressing the expired Children’s Health Insurance Program (CHIP), Congressman Paulsen responds to someone from the “specialty medicine community”.

What Congressman Paulsen should do is read Elisabeth Rosenthal’s book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back … especially Chapter 5 The Age of Medical Devices.

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