Feb 8, 2018

Congress keeps undoing its own efforts to control health care costs

A bipartisan budget deal would repeal part of the Affordable Care Act. Photo: Tom Williams/CQ Roll Call

Everybody wants to control health care costs — until it’s time to actually control health care costs.

Driving the news: The bipartisan budget deal unveiled yesterday in the Senate would repeal the Affordable Care Act’s Independent Payment Advisory Board. It’s merely the most recent time Congress has voted, with bipartisan support, to chip away at programs that aimed to slow the growth in health care spending, or at least help balance the federal checkbook.

The impact: Repealing the IPAB takes away what was initially seen as one of the ACA’s most significant cost-control measures.

  • The IPAB was conceived as an independent, expert board that would make targeted reductions in Medicare payments to doctors, hospitals and other providers — it’s legally prohibited from directly cutting benefits — if the program’s overall spending grows faster than a prescribed rate.
  • No one has ever been appointed to the IPAB, and Medicare spending hasn’t grown fast enough to trigger it, anyway.
  • Still, it’s never sat especially well with lawmakers, who saw it as a usurpation of their power. And providers have always hated it, because its whole purpose is to cut their payments.

It’s not just the IPAB.

  • The budget deal also would "slow down federal efforts to hold providers accountable for reducing Medicare costs," Modern Healthcare reports.
  • Congress has repeatedly agreed to delay the ACA’s tax on expensive employer-based health plans. That’s also a cost-control measure — one of the law’s most powerful, in fact.
  • Under former secretary Tom Price, and with many congressional Republicans’ support, the Health and Human Services Department rolled back several ACA-based pilot programs that sought to control health care spending.
  • Lawmakers have also agreed to delay or freeze the law’s taxes on medical devices and health insurers — which weren’t necessarily designed to control health care costs, but which nevertheless helped make the ACA a net deficit-reducer for the federal government.

The bottom line: One person’s cost control is another person’s pay cut — and that fact will always complicate the execution of these ostensibly shared goals.

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