Take care with access to Medicare

October 16, 2010 

— Nearly 2 million people in our state lack health insurance. Fortunately, the president's health care bill - some of which recently went into effect - will help expand coverage to most of these North Carolinians.

That's why this legislation, regardless of our various political positions, is worth applauding.

Yes, some worrisome changes to Medicare have been proposed, some that could impact the lives of the nearly 1.5 million Medicare recipients in North Carolina. For the 56 percent of state Medicare enrollees living in poverty, even minor adjustments in benefits could dramatically compromise their health care

Virtually everyone agrees on the need to get Medicare spending under control. The program faces a staggering $38 trillion shortfall during the next 75 years. From 1995 to 2004, current figures show that Medicare spending grew 6 percent annually at a time when inflation was low. Astonishingly, North Carolina's annual Medicare spending grew 33 percent higher than the national average.

To control Medicare costs, the federal health care law creates a new panel called the Independent Payment Advisory Board (IPAB). The IPAB is made up of no more than 15 presidential appointees. It's scheduled to begin its efforts to cut Medicare spending in 2015.

Such cuts are meant to keep Medicare under preset spending limits that, starting in 2018, will be tied to growth as applied to per-capita gross domestic product. The IPAB's recommendations will become law unless they are overridden by a three-fifths majority vote in Congress - or if Congress proposes its own plan to keep costs under the spending cap.

The hope is that independently named experts, such as these appointees, will be immune to the political pressures that have made it difficult for Congress to tackle Medicare cuts in the past. Still, many of us are concerned that it might be dangerous to hand such unaccountable bureaucrats the power to dictate significant changes in this all-important program.

True, IPAB's powers are limited in some ways. It's prohibited from adjusting eligibility requirements, directly reducing benefits and making changes to co-pays or premiums. In fact, the primary effect the IPAB can bring about is to allow broad cuts to Medicare reimbursement rates for participating health care providers - by no means a small undertaking.

There is ample evidence, however, that lowering reimbursement rates will reduce access to care. As things stand now, Medicare isn't paying doctors enough. Current data shows that half of all local doctors are not accepting new Medicare patients, largely because reimbursement rates are so low. Sadly, the latest studies also show that 100 to 200 doctors in North Carolina are abandoning Medicare entirely.

Low reimbursement rates have already made it tough for Medicare patients across the United States to find a doctor. A 2008 survey from the Medicare Payment Advisory Commission found that 29 percent of Medicare patients struggle to find a primary care physician.

What does this all mean for North Carolinians? After the elections in November, there likely will be a vastly different dynamic on Capitol Hill. Newly empowered Republicans will almost certainly attempt to chip away at the health care bill. Simultaneously, Democrats are pretty much certain to dig in and defend it.

Regardless of the outcome, North Carolinians should call on their elected officials to fight for our state's best interests by reforming the IPAB. Correcting this situation is a rare opportunity for both parties to come together. This way, together they can help make the health care laws better.

Many of the solutions we need already exist. The most critical steps now include addressing the duplication of services and the government's efforts to reduce fraud. North Carolinians must demand that their elected officials give them genuine spending controls in Medicare - changes that sustain the program but don't reduce seniors' access to treatment.

Without such a commitment, too many citizens will continue struggling to find acceptable health care solutions. If we truly care about our neighbors - and surely the majority of us do - then we must make this happen.

Dr. Cedric Bright is president of the Durham-based Old North State Medical Society, which represents about 1,200 African-American physicians throughout North Carolina.

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