The ACP Advocate Blog
by Bob Doherty
Wednesday, February 29, 2012
Much ado about IPAB
Congressional Republicans and some Democrats have set their sights on eliminating the Independent Payment Advisory Board (IPAB) authorized by the Affordable Care Act.
Today, the House Energy and Commerce Committee voted 17-5 to repeal IPAB, with the support of Frank Pallone (D-NJ), the ranking Democrat on the committee. The House likely will take up and pass the IPAB repeal bill later this year. Prospects for IPAB repeal in the Senate are far less certain, but even if repeal were to pass the Senate, President Obama could veto it. So IPAB likely will remain on the books for now.
Even if IPAB survives, it is unlikely to do much of anything for at least another six years. The members of IPAB won’t even be named by the President until 2014—and they would have to first be confirmed by the Senate (where their nominations likely would be subject to a filibuster by IPAB opponents). Then, assuming the President is able to get IPAB members confirmed, the board will submit recommendations to Congress to reduce costs only if spending exceeds a target rate of growth set by the statute. That likely won’t happen until 2018, at the earliest, according to HHS Secretary Kathleen Sebelius. IPAB’s recommendations would then automatically go into effect unless a “Super Majority” of Congress voted to override it. Even so, IPAB is prohibited from making any recommendations to ration health care, raise revenues or Medicare beneficiary premiums, increase Medicare beneficiary cost sharing, or otherwise restrict benefits or modify eligibility criteria.
(You can learn more about how IPAB is supposed to work in “The Internist's Practical Guide to Health System Reform,” published by ACP’s governmental affairs division.)
So IPAB hardly is a clear and present danger to anyone, if it ever will be.
Yet you wouldn’t know that from the rhetoric being hurled at it—with some calling IPAB a “death panel” or “rationing board.”
And, as Don Taylor explains in the Incidental Economist blog, some prominent Republicans—who today are ardent foes of IPAB—proposed similar unelected cost control boards. The Patients’ Choice Act, introduced in 2009 by Rep. Paul Ryan (R-WI), now chair of the House Budget Committee, would have created an unelected quality commission with authority “to make recommendations to the Secretary to enforce compliance of health care providers with the guidelines, standards, performance measures, and review criteria adopted [by the commission]. Such recommendations may include the following, with respect to a health care provider who is not in compliance with such guidelines, standards, measures, and criteria: (1) Exclusion from participation in Federal health care programs . . . and (2) Imposition of a civil money penalty on such provider.”
The point is that many Republicans and Democrats used to agree that an independent board of health care experts and clinicians could help the country decide on the difficult tradeoffs involved in controlling health care costs, outside of the usual political process where powerful health care industry lobbies can effectively block any legislation that hurts their economic interests.
For its part, ACP “believes that an independent board of physicians and other healthcare experts would be more likely to achieve needed Medicare changes, and be less affected by undue special-interest influence,” than Congress. The College believes that the IPAB has the potential to serve this role, but requires some significant modification—including amending the law to allow Congress to reject IPAB’s recommendations with a simple majority vote.
Maybe a future Congress will be able to demonstrate that it can make tough cost control decisions on its own, even if this means going against the special health care interests that fund the lawmakers’ campaigns. Maybe it doesn’t need an independent group of experts who really understand health care to help it figure out the most effective policies—and provide political cover for the unpopular tradeoffs involved. Maybe…but why in the world would anyone believe that Congress is up to the task?
Today’s questions: Do you think an independent board of health care experts is needed to help Congress make decisions on controlling health care costs? What do you think about the argument that IPAB will lead to rationing and “death panels”?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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