November 18, 2010 | by David Mixner
Details of health care reform still to be worked out

Over the years, HIV/AIDS activists and their allies have been pioneers in creating new frontiers in the medical establishment. Through their efforts, the FDA drug approval procedures were reformed so promising new therapies could reach desperate patients quicker. The heroic efforts of the HIV/AIDS community has made health care better for millions of Americans.

I celebrated the passage of the new health reform law. It has given Americans living with HIV/AIDS much reason to hope. But even in victory, there are important details that must be worked out. We should not be afraid of making changes that will protect patient rights and total care. One such change that is needed relates to the Independent Payment Advisory Board (IPAB).

IPAB is a new entity comprised of 15 presidential appointees and tasked with cutting Medicare spending. Its recommendations automatically become law without congressional action. And it is wholly exempt from judicial or administrative review.

These are high stakes for the HIV/AIDS community. In 2006, Medicare became the single largest source of financing for HIV care. Today, nearly100,000 people with HIV rely on Medicare for coverage.

Here are four reasons why IPAB is bad for the HIV/AIDS community.

1. IPAB will disrupt the doctor-patient relationship.

For many people with HIV, finding the right doctor is the most important decision they’ll make. But IPAB is likely to drastically cut reimbursements to physicians, prompting many to leave the Medicare system. Doctors that treat HIV/AIDS are highly trained specialists that are particularly sensitive to payment cuts.

Make no mistake: Pushing HIV specialists out of Medicare will compromise patients’ health. Treating HIV/AIDS is extremely complicated. HIV specialists fight an array of progressive, often life-threatening complications with multiple medications that require close and ongoing monitoring. And since many patients become resistant to their medication over time, treatment regimens must change frequently.

2. Patients and their doctors cannot appeal IPAB’s decisions.

Patients have no recourse to appeal any decision made by IPAB. Doctors, who know better than anyone about the care a particular patient needs, are also unable to appeal IPAB’s decisions. Without patient or doctor input, the HIV/AIDS community will be left at the mercy of 15 unelected bureaucrats who can make major changes to Medicare.

3. There’s effectively zero congressional oversight.

To prevent an IPAB recommendation from becoming law, Congress can either outright reject it via three-fifths majority vote, or propose its own plan to achieve the same amount of savings. Both these possibilities are politically unlikely.

What’s more, the law requires Congress to act within an extremely short time period. And even if Congress were to achieve this minor miracle, the president could still veto their decision.

It’s not certain Congress would intervene if the IPAB’s decisions were to result in fewer HIV/AIDS specialists or limited treatment options. After all, part of IPAB’s appeal is that it insulates Congress from actually having to make politically unpopular Medicare cuts.

4. IPAB will scare away funding for medical research.

Medical innovations have dramatically reduced HIV/AIDS-related deaths in this country and throughout the world.

But we’re still years away from an actual cure or vaccine. And while current anti-retrovirals are extending some lives, not everyone can benefit from them. Around 40 percent of patients with access to these improved medications are either unable to tolerate them or cannot adhere to the complex treatment schedule.

We must continue to develop new treatments and work toward a cure. Developing these drugs is expensive, however. Getting a traditional pharmaceutical to the market can cost a billion dollars or more. Newer, more targeted drugs called biologics are even more expensive to make.

If IPAB lowers reimbursement rates to providers in the Medicare drug benefit, biopharmaceutical researchers will find themselves with fewer resources to investigate new treatments.

The HIV/AIDS community cannot forget this lesson of the past: If we’re not on top of an issue, we’ll get left behind. IPAB is just such an issue. Left unmodified, it will undo much of the progress we’ve made over the last two decades. The HIV/AIDS community must fight to protect the gains we’ve made and ensure that all patients get the care they need.

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