By Suzanna Masartis

Pennsylvania has one of the oldest populations in the nation. Nearly one in four residents is over 65. By 2020, the number of senior citizens will jump by 25 percent.

Unfortunately for these folks, two federal initiatives are planning cuts to Medicare.

Unless Congress and the Trump administration reform or scrap these initiatives, more than 2 million Pennsylvania seniors could lose access to health care.

The Independent Payment Advisory Board (IPAB) is the first one. Established by the Affordable Care Act, IPAB exists to slash spending if Medicare costs rise too quickly.

Medicare spending has grown slowly in recent years, so IPAB has yet to be activated.

If that spending growth ramps up, President Donald Trump will have to appoint 15 officials to the board. That's if Trump can make a decision. If he cannot, Secretary of Health and Human Services appoints the IPAB board.

Those officials would almost certainly recommend cutting reimbursement rates for advanced medicines and surgical procedures.

If Medicare no longer pays doctors enough to cover the cost of top-of-the-line treatments, physicians will stop providing those treatments.

In effect, IPAB would ration care for the sickest and most vulnerable Medicare patients.

These IPAB recommendations can become law over the objections of Congress. If legislators don't pass a different set of cuts that are just as deep, IPAB's plan automatically becomes law.

Courts are barred from reviewing its actions.

The only way Congress can prevent IPAB from harming millions of seniors is to repeal it now, before the panel ever convenes.

The other initiative that could inflict grave harm on seniors is the Center for Medicare and Medicaid Innovation (CMMI).

Also established by the ACA, this agency is supposed to put together small-scale "demonstration projects" that help the government test ways to save Medicare money and improve care.

But just as there were with IPAB, there are several issues with CMMI as well.

First, the agency's projects are not "small."

The most stunning example of this was a proposal last year regarding Medicare Part B, which covers drugs, such as chemotherapy, that physicians must administer. Physicians pay for these drugs up front and then Medicare reimburses them.

The agency's proposal would have slashed reimbursement rates for the most advanced drugs. The lowered rates may have forced many physicians to stop prescribing these drugs, essentially restricting beneficiaries' access to them. More than 75 percent of Medicare providers would have been affected by the proposal.

Fortunately, after an outcry from patient groups, medical providers, and legislators across the political spectrum, CMMI abandoned the experiment.

Consider another mandatory demonstration that CMMI finalized in late 2015. This experiment required 800 hospitals -- about 15 percent of all U.S. hospitals -- to accept a different payment model for hip and knee replacements. In 2016, another demonstration took a similar approach to cardiac care and required the participation of hospitals in one-quarter of all metro areas.

These payment changes would have caused many patients to be given old treatments rather than modern ones. Fortunately, officials have proposed making these demonstrations voluntary rather than mandatory.

That's the right idea -- CMMI could do some good if it actually tested new ideas on a limited, voluntary basis.

That's a change that CMMI's parent organization, the Centers for Medicare and Medicaid Services, plans to implement. Imposing some guardrails on CMMI would ensure that demonstrations don't turn into wholesale changes to Medicare. Congress ought to have the authority to end demonstrations as needed.

Pennsylvania seniors and patients suffering from diseases, including those with liver disease whom I support, should be able to access the care they need. Repealing a bad law and reforming a stumbling agency will help to ensure that they can.

Suzanna Masartis is the executive director of the Community Liver Alliance, an advocacy group with offices in Pittsburgh.