The Other Stealthy ObamaCare Menace

WSJ:

The Affordable Care Act’s Independent Payment Advisory Board has been so heavily criticized for being an unaccountable body with the power to effectively ration Medicare services that many congressional Democrats no longer support it. IPAB’s bureaucratic cousin—the Center for Medicare and Medicaid Innovation—deserves the same treatment.

Both institutions are in place to preserve rather than reform Medicare’s traditional, and broken, fee-for-service Medicare program. They both also embrace the ObamaCaretechnocratic mind-set.

IPAB’s 15 supposed experts (yet to be nominated by the Obama administration) are charged with governing a program with more than 50 million enrollees. The unstated yet clear agenda is to impose stricter price controls within Medicare. The long, sad history of price regulation—in Medicare and elsewhere around the world—reveals that these controls cut costs only by lowering quality and inducing non-price rationing (e.g., queues).

The Center for Medicare and Medicaid Innovation has flown below the political radar. That’s due to its seemingly innocuous mission: promoting new and more efficient “payment systems” and “models of care.” But this agency is just as dangerous as IPAB. It is a bureaucracy within the massive Department of Health and Human Services superstructure and therefore run by the president’s political appointees. But unlike most of the federal bureaucracy, the agency never has to go back to Congress to get an appropriation.ObamaCare provided it with $10 billion, upfront, to cover its costs for a full 10 years.

At the end of that first decade, and every decade thereafter, the agency will get another $10 billion appropriation. This massive infusion of funding has allowed the Center for Medicare and Medicaid Innovation to grow from 68 employees in 2012 to a planned 440 full-time workers in 2015. About 10% of the agency’s funding is going to personnel and administrative expenses.

Permanent, recurring appropriations are sometimes provided to federal agencies fighting fraud and abuse. But Congress generally requires other agencies to request a new appropriation every year. It’s one important check against bureaucratic abuse of power. And it’s a check that this agency will never have to go through.

The statute also gives the Center wide-ranging authority to alter the Medicare and Medicaid programs without further congressional action. It is supposed to be testing new ways to pay providers of medical services. Changes that are found through pilot programs to reduce costs without harming quality, or found to be budget neutral while improving quality, can be implemented nationwide through regulatory fiat.

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