January 29, 2018

U.S. Senate
Washington, D.C. 20510

Dear Senator,

On November 2, 2017, the House of Representatives passed H.R. 849 by a vote of 307 to 111, the Protecting Seniors’ Access to Medicare Act of 2017, a bill introduced by Reps. Phil Roe (R-Tenn.) and Raul Ruiz (D-Calif.), which would repeal the Independent Payment Advisory Board (IPAB).  On behalf of the millions of members our respective organizations represent, we respectfully ask that the Senate take up H.R. 849 immediately.

IPAB is supposed to be composed of a 15-member unelected board, appointed by the president. While the Affordable Care Act (ACA) bars IPAB from raising premiums, increasing cost sharing, or restricting benefits for beneficiaries, it can cut payments to doctors, hospitals, and other providers.  Reduced payment rates will encourage providers to treat fewer Medicare beneficiaries, raise prices for private sector consumers to offset their losses from seeing Medicare patients, or both. Even though the ACA specifically states the board cannot “ration” care, that is a distinction without a difference; if a physician must reduce the number of Medicare patients he or she treats because of reduced rates, seniors by default will have their care rationed. Moreover, IPAB’s decisions are not subject to judicial review and legislative oversight.

But IPAB’s power goes beyond controlling Medicare outlays. ACA requires the board to consider the private sector’s effects on healthcare costs. It has the authority to write regulations that modify both government and private healthcare, provided IPAB finds that its edicts are related to Medicare.

Because of IPAB’s unprecedented power, members of Congress from both sides of the aisle have long opposed its existence. In addition to the House-passed bill, Sen. Ron Wyden (D-Ore.) introduced S. 251, the “Protecting Medicare from Executive Action Act of 2017,” which has 14 Democratic cosponsors.  Sen. John Cornyn (R-Texas) introduced S. 260, “The Protecting Seniors’ Access to Medicare Act,” which has 37 Republican cosponsors and is identical to the Rep. Roe’s legislation. Therefore, ample reasons exist for the Senate to move forward.

Too much power is being vested with an unelected board, or one person (the secretary of Health and Human Services if the board has taken no action to prepare a proposal to cut spending). We urge the Senate to take up H.R. 849 as soon as possible and return decision-making and spending authority to Congress. It is time to finish the job the House began and get H.R. 849 to President Trump for his signature.

Sincerely,

Thomas Schatz
President
Council for Citizens Against
Government Waste

Pete Sepp
President
National Taxpayers Union

Grover Norquist
President
Americans for Tax Reform

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