Key ACA Provision Regarding Medicare Spending Oversight Finds Many Foes

Recent concerns of two members of congress have upped the ante in the war against a key provision of the ACA: the development of an independent payment advisory board^{[concerns of two members of congress have upped the ante in the war against a key provision of the ACA: the development of an independent payment advisory board^[1] for the purpose of overseeing payments made by Medicare in the event of rapid spending growth in the healthcare delivery sector. It’s just the latest argument in the ongoing saga to balance the major deficit facing the federal government in the wake of world crises, skyrocketing fuel prices, and the controversial Ryan plan.}

[This board differs from the current Medicare Payment Advisory Commission (MedPac), in which recommendations to Congress do not have to be acted upon. If fact they can be ignored.]

Essentially, the panel would have total control over the direction of Medicare spending once it hits the regulatory criterion in comparison to overall government spending. Championed by Kathleen Sebelius and Sen. Jay Rockefeller, the provision for board oversight would “ensure that health costs are reduced” at the discretion of “experts, using evidence, not by the undue influence of special interests”.

The GOP are fearing regulation under the guise of a presumptive non-partisan body (appointed by the president) and don’t like it one bit. Cries of the potential for “rationing boards” and interference in market forces by third parties that contract with Medicare to provide payments to healthcare providers at the hands of non-vetted “bureaucrats” are representative of that party’s concerns.

Perhaps what is a little surprising is the lukewarm reaction by many advocacy lobbies — from the AARP to the American Health Care Association — to Obama’s provisions. The focus on setting Medicare spending policy by unelected officials and the strong potential for policy decisions to be made by unaccountable and seemingly dispassionate arbiters of oversight and governance is of grave concern to these and other groups whose core constituencies (mainly those in long term care and chronic healthcare delivery to seniors) are directly affected by such decisions. The lobby groups allege the legislation of healthcare benefits to seniors by bypassing lawmakers’ authority would result in adverse consequences to coverage and access.

Appointees to the commission are chosen by President Obama and would require Senate confirmation. Currently, Democrats have slim control of the balance of power in that body.

Under the PPACA provision, the board cannot make recommendations to ration healthcare delivery, raise revenues or increase beneficiaries’ premiums, deductibles or co-payments. Recommendations of the board will become law unless the House and the Senate each adopt, by a 3/5 majority, a resolution to block them.