Sen. Jay Rockefeller (D-WV) recently introduced legislation that would make the Medicare Payment Advisory Commission (MedPAC) part of the executive branch. The proposal is at once both logical and worrisome.
His rationale for the MedPAC Reform Act of 2009 (S.B. 1110), which he introduced last week, is to give MedPAC more power to make policy decisions. He wants to take away Medicare policy decisions from Congress, which is subject to the influence of lobbying groups and special interests. The new agency would operate more like the Federal Reserve, which implements policy (most obvious is the setting of interest rates) and is more insulated from special interests.
The bill has merit. It’s hardly a secret that MedPAC, whose members are appointed by the Government Accountability Office, is not very credible in the eyes of Congress. Just consider its recommendations to Congress regarding market-basket updates for skilled nursing facilities.
Over the past several years, MedPAC has recommended that Congress not offer Medicare updates for skilled nursing facilities. Each time, Congress has ignored MedPAC’s suggestions.
If it has no authority, and its recommendations are not taken seriously, what purpose does it serve?
As a little bit of history, MedPAC was established by the Balanced Budget Act of 1997. It was set up as an independent legislative agency to advise Congress on issues affecting Medicare. BBA was not exactly a welcome development for the skilled nursing community. Is it surprising, therefore, that MedPAC hasn’t exactly lived up to expectations?
Still, the idea of giving MedPAC decision-making power over Medicare market-basket rates could end up hurting the skilled nursing community.
After all, Congress has disregarded MedPAC’s suggestions each year for a reason: They are often not practical, given the real-world situations that nursing homes and other providers are facing.
Congress is subject to special interests, but it is also accountable to its constituents who have the right to tell lawmakers what they think, particularly when it comes to funding for vulnerable seniors. That is part of our democracy too.
Maybe the answer is not to move MedPAC to another branch, but to shift its function altogether. Instead of weighing in on Medicare reimbursements, it should focus solely on finding ways to improve the program as part of the larger healthcare reform effort taking place in Washington.
