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Turn the ACA's Biggest Failing Into a Win for Democrats | Commentary

By Ronald Klink House Republicans have launched countless assaults on the Affordable Care Act, or Obamacare as they like to call it, and the number of repeal votes has reached a level of comedy and tragedy.  

Democrats should continue to fight tooth and nail to defend president's landmark health care law, which has drastically reduced the national uninsured rate. But one provision in that bill has got to go, the Medicare cost-cutting panel known as the Independent Payment Advisory Board. This is where the Republicans are right. It has to go. Furthermore, smart Democrats should join the fight to eliminate IPAB, as it poses a serious threat to the quality of Medicare.  

IPAB was included in the Affordable Care Act as a tool for keeping health costs in check. The panel consists of 15 health care experts appointed by the president. If Medicare's projected spending levels exceed federal targets, the board steps in to take an ax to the program. Congress gives up that authority.  

Growing Medicare costs are a major problem for our health system. Spending on the program is expected to almost double over the next decade, from $606 billion in 2014 to nearly $1.2 trillion in 2025, according the Congressional Budget Office.  

IPAB, however, is no solution.  

For one, the unelected panel has enormous authority to sidestep Congress when slashing Medicare spending. In theory, Congress can reject IPAB's recommendation. But such an override would require lawmakers to devise an alternative cost-cutting measure and pass it quickly — a nearly impossible task, given Washington's partisan bickering.  

Congressional representatives — not unelected bureaucrats — should be the only ones with the authority to implement major health care changes that impact millions of Americans.  

Most troubling, IPAB members are free to cut reimbursements to Medicare providers. Such payment reductions would do significant harm to the quality of care and options enjoyed by seniors, limiting their treatment options and making it harder for them to find a physician.  

In fact, a survey from the Physicians Foundation finds that more than half of doctors have either already "limited the access Medicare patients have to their practice or are planning to do so." If IPAB reduces payments to doctors, access is likely to become even more restricted for Medicare patients.  

In short, IPAB members exercise unprecedented power over the medical care of American seniors, and they do so without being answerable to voters, doctors, or even Congress. That's why more than 300 organizations — representing everyone from seniors to doctors to hospitals — have criticized the program.  

Unfortunately, the president's own 2016 budget only increases the panel's authority. In it, the White House proposes lowering Medicare's target growth rate. That would allow IPAB to enact even deeper cuts to the program.  

Democrats should join Republicans to repeal IPAB because it's the right thing to do for America's seniors. But it's also a savvy political move.  

For starters, it would neutralize one of the GOP's most effective arguments against Obamacare: that the health care reform jeopardizes seniors' health care by cutting Medicare funding. Scrapping IPAB would reassure voters that Democrats are committed to a strong, fully-funded Medicare program.  

And clearly some Democrats understand the need to address this issue. Representative Linda T. Sánchez, D-Calif., who is the lead sponsor on legislation to address the IPAB provisions from the law, recently was joined by six of her Democratic colleagues in voting to strike IPAB at a committee markup. Hopefully, when the legislation comes to the House floor for a full vote, more members will follow her leadership.  

Democratic sponsorship and support of an IPAB repeal bill would also give the party momentum to propose true reforms that cut spending without harming the quality of care. Instead of focusing on immediate, annual cuts to Medicare — as IPAB does — a more effective approach should address the long-term drivers of rising costs.  

Such a reform would need to make the prevention of chronic illnesses a central objective. According to a Centers for Disease Control and Prevention analysis from 2013, more than two-thirds of Medicare beneficiaries suffer from two or more chronic diseases, which include conditions such as diabetes, hypertension and cancer.  

Together, these patients are responsible for roughly 93 percent of Medicare spending. Reforms aimed at preventing chronic illnesses — smoking cessation programs, for instance, or diet counseling initiatives — could have a dramatic effect on health costs in the long run.  

Other reforms could build on the ACA's goal of better coordinating medical care. Congress should encourage health care professionals to share information, work in concert, and avoid unnecessary procedures. That would eliminate wasteful spending, while improving the overall delivery of care.  

Democrats, in other words, understand the policies needed to make Medicare sustainable for years to come. The first step in realizing that goal, however, is admitting that IPAB is a misguided, harmful policy, and ending it as soon as possible.  

Eliminating IPAB would be a victory for seniors whose health and well-being depends on Medicare. If Democrats rally behind such the effort, it could also prove a victory for Medicare, the ACA, and the lawmakers who seek to defend and improve these programs.  

Ronald Klink, a Democrat, is a former representative from Pennsylvania. Correction 3:32 p.m. A previous version of this op-ed misstated Klink's party affiliation.  

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