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  • Protecting Seniors’ Access to Medicare Act of 2015

    by Representative Sander M. Levin

    Posted on 2015-06-18

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    LEVIN. I yield myself such time as I may consume.



    The real purpose of this bill at this time, indeed, is to take a further effort to repeal ACA. That is really what this is about at this particular moment. The Republican leadership is, yet again, taking aim at ACA. H.R. 1190 would repeal the Independent Payment Advisory Board, IPAB. This would really be the 59th vote to repeal or undermine ACA.

    Since it passed, we have seen the slowest growth in healthcare prices over any period of that length in nearly 50 years. Growth in per enrollee healthcare spending across both the public and private sectors has been controlled.

    The three slowest years of growth in real per capita national health expenditures on record were 2011, 2012, and 2013. The ACA, in essence, has changed the healthcare cost landscape, keeping cost increases down and keeping or helping, at least, to keep families out of debt.

    While we know the Medicare delivery system reforms have been working to deliver value and lower costs, the IPAB was created as a backstop--a backstop--only to come into effect if other efforts weren't successful. This should be clear. IPAB only comes into being if delivery system reforms aren't doing their job to manage Medicare.

    According to the CBO, Medicare growth rates are projected to remain beneath IPAB targets throughout the entire budget window, thereby not triggering the Board's provisions until 2024. I think, when you subtract 2015 from 2024, you get 9 years; so here we are, on this date, at this time, 9 years, according to CBO, before the provisions would come into effect, asking this Congress to repeal the IPAB provision.

    If the ACA's delivery system efforts continue to be successful, IPAB may never even need to be constituted. It is specifically prohibited from cutting benefits or raising costs on seniors.

    What IPAB can do, however, is to make recommendations to go after overpayments, go after fraud and abuse, and try to improve, if needed, the way there is reform of the delivery system. IPAB will not take away Medicare benefits; it will not shift costs to seniors.

    If we in Congress are doing our job as stewards of Medicare, we can manage cost growth while protecting beneficiaries on the front end. In the event IPAB makes recommendations, Congress always has the ability to disapprove or modify them. If we do our job, we won't need IPAB. If we fail to do our job, IPAB will prod us to action 9 years from now or perhaps even later.

    Let me talk a few words about the offset. It is a significant reduction of funding for the prevention and public health fund. While the Republicans so far have come forth with their proposals that are never paid for, this time, they have decided to have a pay-for, but it would cut by half or more than that the current funding for the prevention and public health fund.

    That fund was established in the ACA to provide expanded and sustained national investments in prevention and public health and will provide $900 million this year alone for interventions that will reduce smoking, tackle heart disease, and help improve prenatal outcomes.

    I have a listing of what it has meant for Michigan, just as one example: $3.5 million for State health department efforts to prevent obesity and diabetes; $3.8 million to address chronic disease risk factors among African Americans, American Indians, Latinos, and other minorities; $3.3 million for community transformation grants in central Michigan to address heart disease prevention and diabetes; and almost $3 million for tobacco use prevention.

    Here we are, at long last, the Republicans come forth with a pay-for, and they are paying for it by taking away something that really, really matters.

    We have in front of us a Statement of Administration Policy, and I ask that it be placed in the Record. It just repeats some of the points that I have [[Page H4530]] made, so I will leave it just to be entered into the Record; and, therefore, I will now say that we should not vote for this legislation.

    It would repeal a part of ACA designed to help keep healthcare costs under control, and so importantly, it would cut critical public health and prevention funding.

    I reserve the balance of my time.

    Statement of Administration Policy H.R. 1190--Protecting Seniors' Access to Medicare Act of 2015 (Rep. Roe, R-TN, June 15, 2015) The Affordable Care Act has improved the American health care system, on which Americans can rely throughout life. After more than five years under this law, 16.4 million Americans have gained health coverage. Up to 129 million people who could have otherwise been denied or faced discrimination now have access to coverage. And, health care prices have risen at the slowest rate in nearly 50 years. As we work to make the system even better, we are open to ideas that improve the accessibility, affordability, and quality of health care, and help middle-class Americans.

    The Independent Payment Advisory Board (IPAB) will be comprised of fifteen expert members, including doctors and patient advocates, and will recommend to the Congress policies that reduce the rate of Medicare growth and help Medicare provide better care at lower costs. IPAB has been highlighted by the non-partisan Congressional Budget Office (CBO) economists, and health policy experts as contributing to Medicare's long-term sustainability. The Board is prohibited from recommending changes to Medicare that ration health care, restrict benefits, modify eligibility, increase cost sharing, or raise premiums or revenues. Under current law, the Congress retains the authority to modify, reject, or enhance IPAB recommendations to strengthen Medicare, and IPAB recommendations would take effect only if the Congress does not act to slow Medicare cost growth.

    H.R. 1190 would repeal and dismantle the IPAB even before it has a chance to work. The bill would eliminate an important safeguard that, under current law, will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries and the traditional program. While this safeguard is not projected to be needed now or for a number of years given recent exceptionally slow growth in health care costs, it could serve a valuable role should rapid growth in health costs return.

    CBO estimates that repealing the IPAB would increase Medicare costs and the deficit by $7 billion over 10 years. The Administration would strongly oppose any effort to offset this increased Federal budget cost by reducing the Prevention and Public Health Fund. The Affordable Care Act created this Fund to help prevent disease, detect it early, and manage conditions before they become severe. There has been bipartisan and bicameral support for allocation of the Fund, and the Congress directed uses of the Fund through FY 2014 and FY 2015 appropriations legislation. The Fund supports critical investments such as tobacco use reduction and programs to reduce health-care associated infections. By concentrating on the causes of chronic disease, the Fund helps more Americans stay healthy.

    The Administration is committed to strengthening Medicare for those who depend on it and protection of the public's health. We believe that this legislation fails to accomplish these goals. If the President were presented with H.R. 1190, his senior advisors would recommend that he veto the bill.

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