Today is the 46th anniversary of Medicare. On July 30, 1965, President Lyndon Johnson signed into law an amendment to the Social Security Act which established Medicare as the health insurance program for Americans 65 of older, and Medicaid, to provide health coverage to certain low-income people. In 1972, during the Nixon Administration, eligibility for the program was extended to people under 65 with certain disabilities; and in 2003, President George W. Bush signed the Medicare Modernization Act which added outpatient prescription drug benefits to the program. Approximately 45 million Americans are beneficiaries of Medicare/Medicaid services today.

Despite these staggering numbers the program, arguably, is under the most serious threat to its ability to deliver health care to some of America's most vulnerable populations. This is due to a provision in Health Care Reform which created the Medicare Independent Payment Advisory Board (IPAB). IPAB was created and given a broad mandate to achieve cost savings in the program when the Centers for Medicare and Medicaid Services (CMS) indicate the program has exceeded certain budget targets.

This new agency is a major concern to health care experts because it wields inordinate power to cut spending without accounting for the impact on patients. There is no mandate for IPAB to consider if patients may have difficulty finding doctors who accept Medicare because of reimbursement cuts. There are no requirements for IPAB to consider if cutting diagnostic reimbursements means that patients will have to wait to get critical medical tests. There is no mention of IPAB having to evaluate itself, or any negative impact its decisions may have on patients. Most concerning of all, there is no way to appeal an IPAB decision. Neither Medicare patients nor medical providers have the right to appeal any decisions made by IPAB - all decisions are unilateral, and final!

This unprecedented authority has led many health care experts to further express concern about IPAB's ability to impact the access of Medicare patients to new therapies. If, for example, a new treatment for HIV is developed, it would certainly raise Medicare costs in the short-term as doctors prescribe new medications to patients. The problem is that IPAB is not empowered to ask if that is a good thing. It is not enabled to consider the long-term gains of a healthier population. When CMS spending estimates are exceeded, all IPAB can do is cut, since it cannot make changes to benefits. Congress created no mechanism to allow IPAB to consider long-term savings inherent in the development of new technologies and treatments.

On this 46th anniversary of Medicare, the program is confronted by the most serious threat it has ever faced. Political posturing around the debt ceiling is drowning out the voices concerned about IPAB. We should not, and indeed cannot, allow our attention to be diverted by political theater. Congress and the Administration must work together to repeal IPAB from the Affordable Care Act. We have Health Care Reform - now let us make sure it benefits all Americans.

James Sykes
Advocacy Manager, HealthHIV

To download this article as a pdf, click here.