Our Declaration of Independence was based on a government’s over-bearing intrusion in our lives. That’s why the part of the Patient Protection and Affordable Care Act (ACA) that people find most objectionable is the mandate that requires everyone to buy what the government determines is adequate health insurance. It’s simply un-American. In actuality, however, the individual mandate is a small matter compared to other elements in the health care reform law that run rough-shod over what our Founders had in mind when they crafted The Constitution. The Independent Payment Advisory Board (IPAB) and Secretary of Health and Human Services (HHS) are two such elements that threaten our independence because they’ve been given almost unlimited control over our health care and are not accountable to us. We, the people, are no longer in charge.
The most outrageous take-over of our power is the Independent Payment Advisory Board (IPAB). This 15 member panel of political appointees is charged with controlling Medicare costs by lowering the amounts our medical providers are paid for their services. These cuts will be automatically mandated whenever Medicare cost growth exceeds certain targeted rates.
This approach may or may not cut costs. But it will, without a doubt, have disastrous results. Richard Foster, respected Medicare actuary, testified that the rate reductions required by this provision of the law are so great that seniors depending on Medicare services will be seriously harmed. Doctors, nurses and laboratories, he said, would simply stop accepting Medicare patients; and hospitals and nursing homes will go out of business.
This is not an idle threat. Consider what is happening to Medicaid, the government’s health program for the poor. 42 % of primary doctors now refuse to accept Medicaid patients because of Medicaid’s low rates. Poor sick people crowd hospital emergency rooms for basic health services as a result. Foster says this’ll happen to seniors as well since the Medicare cuts called for will fall even lower than Medicaid’s. Seniors and their doctors won’t be the only ones to suffer. Because many private health insurers reference Medicare rates to determine their payment structures, everyone will be effected.
But there’s an even more distressing problem with IPAB. Normally, laws or portions of laws that prove unsatisfactory are repealed. Incredibly, this legislation was written to make IPAB and its dictums nearly impregnable to change. To begin with, according to the health care reform law, Congress cannot intervene with an IPAB mandate unless it comes up with a rule of its own within 30 hours and with a difficult-to-get 3/5 majority. In addition, lest someone bring the courts to bear, the actions of these 15 un-elected appointees cannot be subject to judicial review. Should Congress wish to repeal IPAB altogether, it has just a 7 month window in 2017 to do so. And this requires a 3/5 majority in both chambers! If this effort to kill it fails, the health care law prohibits Congress from ever altering IPAB. We, the people, are no longer in charge and, now, neither are the people we’ve elected or the judges appointed to protect us in charge.
The Secretary of Health and Human Services (HHS) is another element in the health care reform law that is intrusive and unaccountable to us, the people. What makes this particularly disturbing is the unparalleled power this position now holds. In complete disregard for the right of free speech, Kathleen Sebelius, HHS Secretary, threatened health insurance companies with loss of business if they spoke out against the health care reform bill. Then, in a virtual take-over of the health insurance business, health insurers have been told what their profit margin must be and how their profit is to be determined. There are those who might think this is a good thing but government meddling has already raised insurance costs and driven all but the largest insurers out of business. Most recently, the HHS secretary defied first Amendment religious freedoms by commanding that Catholic social services, schools, and institutions must provide birth control and abortion drugs to their employees in defiance of church teachings. And the ‘reforms’ called for in the law are just beginning….
Where in the law is this power given? Altogether, there is an unprecedented number of instances, over 1000, in the 2700 page law that stipulate ‘the Secretary shall’ or ‘the Secretary may’ or ‘the Secretary will determine’. The HHS Secretary will create new offices and agencies, regulate private business, establish rules that determine how and when we can access health care and stipulate penalties for people who won’t comply, to name just a few of the Secretary’s new functions. Pronouncements that should have been discussed and decided by our elected representatives will be determined, instead, by one person behind closed doors. It’s the Secretary of HHS, not our elected officials, who will create a new health care system for you and me.
The powers given to IPAB and the HHS Secretary by the Patient Protection and Affordable Care Act may or may not be technically Constitutional but they clearly are not in keeping with the spirit of our Constitution. They do not reflect the spirit of our Declaration of Independence in which we threw off the shackles of a government that virtually enslaved us. Why would we re-shackle ourselves to un-elected authorities unaccountable to us? There has to be a better way to reform health care.