Healthcare spending negotiations should include entitlement reform

As budget conferees face a rapidly approaching Dec. 13 timeline, I am hopeful that an agreement, whether large or small, can be reached.

An agreement would be important for two reasons: First, it would allow for a return to regular order and more open and transparent debate on all areas of the federal budget; and second, it could also help build trust between the two parties before we face the elephant in the room: the fact that current healthcare entitlement spending will bankrupt America.

Although I’m not optimistic we will achieve a substantive agreement on the latter point, it is what I believe we should be working toward. Earlier this year, the Medicare Trustees reported that, if changes to the program aren’t made, the Hospital Insurance Trust Fund will become insolvent in 2026.

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Make no mistake, change is coming to Medicare one way or another. That’s why House Republicans, led by Budget Committee Chairman Paul Ryan (Wis.), put forth a budget plan that would strengthen Medicare for current beneficiaries and preserve the program for future generations. This proposal would not change Medicare for Americans ages 55 or older, but would allow younger Americans to choose from several approved healthcare plans — including traditional Medicare — the one that best meets their needs. Seniors will be guaranteed access to care, with sicker and poorer individuals receiving additional support.

Adopting a forward-looking approach now would avert a future Washington-generated crisis.

I also hope that conferees will take action to repeal the Independent Payment Advisory Board (IPAB). This unelected, unaccountable board of bureaucrats was established through the president’s healthcare reform law, and does not have authority to make the big-picture changes to Medicare that are required to preserve access for seniors. The IPAB relies on piecemeal changes that will only ensure Medicare meets an annual budget, and won’t help us to make Medicare sustainable. 

IPAB proposals are to be considered using “fast-track” procedures and — absent a three-fifths vote of the Senate — Congress can only modify the type of cuts proposed, not the amount. Should Congress fail to act on the board’s recommendations, they automatically go into effect. To make matters worse, the IPAB is exempt from administrative or judicial review. If the president does not nominate individuals to serve on the board — or if the IPAB fails to recommend cuts to Medicare — the law gives the secretary of the Health and Human Services Department the power to make changes unilaterally. This would leave the power to affect seniors’ healthcare concentrated in one person.

Supporters of the board like to claim that IPAB is prevented from rationing care, and as far as the language of President Obama’s healthcare law reads, that’s true. But dig a little deeper and you find out the word “rationing” remains undefined. The IPAB is not allowed to deny a particular treatment or type of care, but it can cut payments to physicians that perform certain treatments to such an extent that seniors will not be able to find a willing provider. There are better ways to deliver Medicare more efficiently.

Medicaid is also a huge part of the federal budget and, unfortunately, ObamaCare expands an already broken system. The president’s healthcare law will add an additional 20 million Americans to the Medicaid rolls by 2019. My home state of Tennessee should serve as a cautionary tale as to what ObamaCare will do on a national level. TennCare crippled our budget, forced the governor to ultimately drop hundreds of thousands from coverage and is now one of the most restrictive health insurance plans a person can carry.

Nationwide from 2000 to 2009, total spending on Medicaid increased by 83 percent, totaling $378 billion. Instead of expanding an ineffective system, we should be giving our states the ability to experiment with ways to improve Medicaid. Tennessee’s governor has proposed making Medicaid plans more closely resemble the private coverage that so many Americans enjoy, and I think it would be a good idea to let him — and other governors who have proposed equally innovative solutions — try to improve healthcare for the poor. With these proposals, we can change Medicaid so it costs less and covers more.

The conferees have their work cut out for them, but these discussions can serve as an important starting point toward a broader discussion of our spending addiction. I look forward to seeing their proposal and continuing to work to reduce the deficit, cut spending and get our country’s fiscal house back in order.


Roe has represented Tennessee’s 1st Congressional District since 2009. He sits on the Education and the Workforce, and the Veterans Affairs’ committees.