Flying Under the Radar: Administration's Bill to Control Medicare

[clear eye]

from Medicare Update

July 17, 2009

Obama Administration Releases Independent Medicare Advisory Council Act of 2009

The proposed law is billed as giving the President sole authority to approve or disapprove a package of rate changes in Medicare rates recommended by an appointed advisory board unless the Congress passes a Joint Resolution of Congress within 30 days disapproving of the changes. Neither the President nor Congress would be able to break up the package and approve some, but not others, of the proposed changes.

BUT THE KICKER IS that the law also authorizes the 5-member Independent Medicare Advisory Council to create broader "reforms" without limitation that will automatically become law unless the President "disapproves" them or Congress can mobilize to pass a disapproval resolution w/i the brief 30-day period.

And Congress would be prohibited under the act from making any law, whatsoever, regulating any aspect of Medicare on its own!

Even judicial recourse is restricted:

...a person adversely affected by the Council's approved recommendations would have to file an action in the U.S. Court of Appeals for the District of Columbia within 30 days of the President's approval.

However, the scope of the review would be limited to whether the Council's recommendation exceeded the scope of the Council's authority for determining annual payment updates or making reforms. No other judicial review of the recommendations of the Council, or of the President's approval or disapproval of recommendations, would be available.

Of course since the proposed law in its present form doesn't stipulate any limitations on what the Council can do, such a challenge would inevitably fail.

In a letter to Pelosi accompanying the proposed Act, Peter Orzag of the OMB said,

{Pres. Obama}expressed his openness to ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC). One constructive approach to implementing this idea is embodied in legislation introduced by Senator Rockefeller that would make MedPAC an independent Executive Branch agency, empowering it to improve efficiency and performance throughout the Medicare system.

A similar approach to creating a more dynamic and efficient Medicare system is embodied in the attached draft legislation.

The Rockefeller legislation similarly looks to remove Medicare from the control of Congress and place it in the hands of a newly executized MedPAC ostensibly to control costs. However as MedPAC is historically controlled by the AMA, and has repeatedly rejected reducing physician payments or the creation of a program to crack down on the largest segment of unnecessary expenditure--fraudulent billing by MD's of procedures not performed--the serious cost cutting would most likely involve significant cutbacks in coverage and/or the addition of means testing.

Here are the bones of his bill from The Congressional Record - Senate:

S. 1110. A blll to amend tltle XVIII of
the Social Securlty Act to create a sensible
infrastructure for delivery system
reform by renamlng the Medicare Payment
Advisory Commission, making
the Commlssion an executive branch
agency, and providing the Commission
new resoulces and authority to implement
Medicare payment policy; to the
Committee on Finance.
Mr. ROCKEFELLER. Mr. President. I
rlse today to introduce the Medicare
Payment Advisory Commlssion
MedPAC Reform Act, legislation to
Elevate MedPAC to an executive
branch entity and give it the resources
and authority to implement Medicare
payment policies.


...this legislation also establishes
three new advlsory councils to
assist them in their decision-making:
Council of Health and Economic Advisors,
a Consumer Advisory Council,
and a Federal Health Advisory Council
with representatives from the health
care industry.
Lastly, MedPAC's authority to analyze
health servlces research is also enhanced
in this legislation by providing
them with additional resources and
staff to bolster their current analytical
role. Glven the limitations of the current
Medicare demonstration process,
this legislatlon provldes new authority
and resources to MedPAC to design and
evaluate new payment, models through
Medicare demonstrations.

I strongly feel that establishing
MedPAC as an independent executive
branch agency--which can only happen
through an act of Congress--is the type
of bold step forward that can truly
transform our delivery system.

The "advisory" panels whose members may come from anywhere, including the private insurance industry, and which will be the sole body authorized to create any proposed changes to the system, would be able to do almost anything, including turn Medicare into a Medicaid-like program, complete w/ means testing, and/or drastically restrict permitted procedures for the elderly under the guise of cost/benefit. As a result of either change, middle-class or higher citizens wouldn't use it anymore, and it will become as reviled as any dysfunctional welfare program can get. Working class retirees who paid into it all their adult life, will suffer and die with substandard care. Never again could Medicare be held up as an example of a worthy health care financing system to emulate. The protection we had by Medicare being too popular for a Congressperson to dare tamper with will be removed. They can basically gut it, and if Congress doesn't drop everything and move fast enough, there's nothing we could do to stop it. Then Congress can deny responsibility for the disaster by pointing out that it was this rogue executive branch agency, not they, who did all the damage.

Please mobilize everyone you know to beg, demand, plead that Congressmembers not put the control and viability of Medicare outside of the representative side of our government. I also encourage DUers to put posts similar to this one up on other blogs, such as Dkos.

[Cleita]

1. So apparently the Democrats will accomplish what the Republicans couldn't,

destroy Medicare. Well, I'm already resigned to the fact that I will probably die in a ditch some place like a feral cat.

[clear eye]

2. Thank heaven it's not yet a fait acompli.

Please call your congressmembers to oppose S.1110 in the Senate and the Independent Medicare Advisory Council Act of 2009 in the House, and keep the authority to regulate Medicare in Congress, the representatives of the people, not some unaccountable appointed board of who knows who. And ask those you know to do likewise.

That post of yours is some graphic black humor. Let's hope we can stave this off. I'm sending the info to every liberal media person and single-payer activist group that I can think of.

Even if we stall it now, you know they're not finished trying. We have to keep an eye open for this one from now on whenever they speak of a measure to "cut costs" of Medicare.