Do You Know Who is in Charge of Your Health Care Decisions?

This article appeared in The Hill on July 28, 2016

When it comes to Medicare, most seniors rightfully assume that the representatives they elect to Congress are the ones making critical decisions that affect their health care. After all, it’s one of the largest government programs in our country accounting for more than $500 billion in federal outlays and responsible for the health of America’s seniors. What many patients and voters don’t realize, however, is that there is another body in Washington whose power and influence over the future of this program is growing: The Medicare Payment Advisory Commission (MedPAC).

MedPAC (established by the Balanced Budget Act of 1997) is an independent congressional agency whose mandate is to advise Congress on issues affecting Medicare (quite broadly) and provide recommendations. Though this mandate and the commission itself aren’t inherently problematic, a closer look at their role reveals the weight their recommendations carry in Congress and the ability they may have to transform the Medicare program in ways that will impact all beneficiaries.

MedPAC is comprised of seventeen commissioners, all appointed to three-year terms by the administration. Currently, MedPAC is funded at just under $12 million per year by taxpayers with its budget growing each year. Taxpayers have the common sense to know that government-funded bodies rarely, if ever, shrink in size. As Ronald Reagan once said, “Government programs, once launched, never disappear.”

MedPAC commissioners are supposed to represent various stakeholders in the health care industry, bringing varied perspectives to the table when discussing recommended changes to Medicare. Unfortunately, this hasn’t been the case. What began as a commission tasked with researching and recommending changes to improve Medicare, the program has become a powerful, taxpayer-funded body that is unaccountable to patients or voters.

MedPAC’s influence in Washington is growing stronger. Recently, they recommended a number of reforms to Medicare Part D, the prescription drug program, which would increase out-of-pocket costs on certain drugs and sharply reduce copays on non-generic drugs. The commission’s focus has shifted to drug costs, yet none of the commissioners are representatives of the pharmaceutical industry. Instead, the commission is heavily represented by insurers, pharmaceutical benefit managers and others with incentives to demonize drug makers.  Without balanced representation, taxpayers and seniors cannot be assured that decisions will be in the best interest of either.

There is very little room to trust a government-funded, unelected, unbalanced commission without any accountability to the American people.

This isn’t the way democracy was designed to work. A commission of unelected representatives isn’t supposed to make decisions that affect millions of America’s seniors. It’s Congress’ job to reform and improve Medicare to make it more efficient and less costly — it’s why we elect them.