REFORMING THE REFORM
ABOLISH THE INDEPENDENT PAYMENT ADVISORY BOARD (IPAB)
Established by the Patient Protection and Affordable Care Act (ACA), the IPAB is a 15-member government board whose
members are appointed by the president and which essentially has no meaningful Congressional oversight protections. The
principal responsibility of this board is to cut Medicare spending. Proposed spending cuts automatically go into effect if
Congress does not replace the recommendations with cuts of equal magnitude. Congress only has a very short time in which
to pass its own proposal — making it a virtual certainty that the board’s recommendations would be adopted. The AANS and
CNS strongly urge repeal of the IPAB because leaving Medicare payment decisions in the hands of an unelected,
unaccountable governmental body with minimal congressional oversight will negatively affect timely access to quality
neurosurgical care for our nation’s senior citizens and those with disabilities.
ALLEVIATE THE MEDICAL LIABILITY CRISIS
The AANS and CNS support legislation to provide common sense, proven, comprehensive medical liability reform.
Federal legislation modeled after the laws in California or Texas, which includes reasonable limits on non-economic damages,
represents the “gold standard.” The Congressional Budget Office has shown that comprehensive medical liability reform
would save the federal government over $50 billion over ten years. Other solutions should be adopted including: (1) applying
the Federal Tort Claims Act to services mandated by the Emergency Medical Treatment and Labor Act; (2) liability protections
for physicians who volunteer their services; (3) liability protections for physicians who follow practice guidelines set by their
specialties; and (4) clarifying that the ACA did not create any new causes of action.
EXPAND SUPPORT FOR QUALITY RESIDENT TRAINING & EDUCATION
An appropriate supply of well-educated and trained physicians – both in specialty and primary care — is an essential
element to ensure access to quality healthcare services for all Americans. Unfortunately, the nation is facing a serious shortage
of physicians, particularly due to the expansion of health insurance coverage in the ACA. And while medical schools in the
U.S. have increased their enrollments, and additional medical and osteopathic schools have been established, the number of
Medicare funded resident positions has been capped by law at 1996 levels. The solution for increasing physician numbers
involves not only increasing medical student class size and the number of medical schools, but also increasing the number of
funded residency positions. All payers of healthcare – including the federal government, the states and private payers –
benefit from graduate medical education. To ensure an adequate supply of physicians, Congress should eliminate the current
GME funding caps, expand funding for the full length of ACGME accredited training, maintain current financial support for
children’s hospital GME and encourage all other payers to contribute to GME programs.
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