Congress should modify ACA provisions to protect Medicare

Roughly 35,000 Illinois seniors will be diagnosed with cancer in the coming year. Fighting cancer is scary enough and patients shouldn't have to worry about access to their doctors or if treatment will be covered. Fortunately, Medicare helps older and disabled Americans afford medicines, surgeries, and radiation therapy.

However, two federal programs are considering cuts to Medicare reimbursements for doctors and hospitals. That would make it tougher for Illinois' two million Medicare beneficiaries to receive the care they deserve.

These initiatives are the Center for Medicare and Medicaid Innovation (CMMI) and the Independent Payment Advisory Board (IPAB). To safeguard patients, the Trump administration must reform CMMI. And Congress must eliminate IPAB.

CMMI is a byproduct of the Affordable Care Act. The law gives CMMI about $1 billion per year to test new Medicare payment formulas. In theory, by tweaking reimbursement formulas to eliminate waste and inefficiencies, CMMI could reduce spending while improving the quality of care Medicare beneficiaries receive.

In practice, CMMI has a track record of recommending major changes that would worsen Medicare's quality of care. In 2016, CMMI proposed slashing reimbursements on drugs covered under Medicare Part B, which pays for most seniors' cancer treatments. CMMI touted the cuts as a mere test - but would have affected 75 percent of Medicare providers.

Doctors pay for Part B drugs first and then Medicare reimburses them the average sales price of the medicines plus a small add-on fee to cover overhead costs.

CMMI wanted to dramatically reduce the add-on fee. Many physicians would have lost money on every dose of advanced cancer treatments they provided. Nearly half of doctors warned that the cuts might force them to reduce or stop Part B treatments.

Officials eventually shelved the proposal. But they continue to look for ways to dramatically alter Medicare through supposedly limited "tests."

To prevent CMMI from implementing such ill-advised proposals in the future, the administration should rein in CMMI. The Centers for Medicare and Medicaid Services, which oversees CMMI, just released a series of recommendations on how to reform CMMI. For instance, CMMI's tests only should affect a small number of beneficiaries. And doctors' participation in the tests should be voluntary. The administration should finalize these changes before CMMI can implement new tests.

The Independent Payment Advisory Board, another byproduct of the ACA, is charged with holding Medicare spending growth in check. If Medicare exceeds a predetermined growth rate, then IPAB is "triggered." By law, the president would have to appoint 15 members to serve on the board. These nonelected officials would then have the power to make huge cuts to Medicare.

IPAB would likely reduce reimbursements for drugs. Doctors, in turn, may stop offering those treatments. So patients would have to pay for these drugs out-of-pocket or switch to different, possibly less effective medicines.

IPAB may save Medicare dollars, but it would cost seniors' access to their medicines.

IPAB functions with little-to-no oversight. The department's actions are not subject to administrative or judicial review. And once IPAB makes recommendations, Congress has a limited amount of time to come up with alternative Medicare spending cuts. If lawmakers don't suggest their own cuts, the recommendations of IPAB's 15 nonelected members automatically take effect.

Hundreds of medical organizations, like the Illinois College of Emergency Physicians, Illinois State Medical Society, and Illinois Neurological Institute, are fighting to repeal IPAB to protect patients.

Reforming CMMI and repealing IPAB would enjoy bipartisan support. Many members of the Illinois delegation have already co-sponsored legislation that would repeal IPAB, including Democratic Sen. Tammy Duckworth, Democratic U.S. Rep. Brad Schneider, and Republican U.S. Reps. Mike Bost, Randy Hultgren, Darin LaHood, Rodney Davis, Adam Kinzinger, Peter Roskam and John Shimkus.

The tens of thousands of Illinoisans battling chronic diseases shouldn't have to fight their own government too. It's time for Congress and the administration to restrain CMMI and eliminate IPAB, before the CMMI and IPAB deprive Illinoisans of treatments.

John Conrad is the interim president and CEO of the Illinois Biotechnology Innovation Organization. He works in Chicago and lives in Brookfield.