IPAB repeal comes up for House vote

A vote scheduled for March 22 in the U.S. House of Representatives will help determine the fate of the Independent Payment Advisory Board (IPAB), a panel established by the Affordable Care Act to keep Medicare costs in check.

Republicans and a handful of Democrats in both the House and the Senate have voiced their opposition to IPAB. Critics of the 15-member panel of independent experts appointed by the president say that it would provide too much power to non-elected officials and circumvent Congress’ authority to administer Medicare.

“That charge is off base for two reasons,” said Paul van der Water, senior fellow with the Center on Budget and Policy Priorities in a press briefing earlier this week. “First, the IPAB process can give Congress the political cover to make necessary, but controversial, decisions that affect the incomes of powerful healthcare interests. Separate and apart from IPAB, Congress can always enact provisions that will meet the Medicare spending target. It doesn’t need IPAB to do that and IPAB doesn’t restrict freedom to do so."

Another contention among critics that also include conservative action groups and medical associations, including the American Medical Association (AMA), is that IPAB activities will effectively ration healthcare and that if its recommendations are put in place due to Congressional inaction it will unfairly enact across-the-board reimbursement cuts.

The AMA has tied the repeal of IPAB to the sustainable growth rate formula (SGR) provision that has seen Congress need to act yearly, and sometimes monthly, to avert steep cuts to physician Medicare reimbursements.

“We have made it clear to Congress that the IPAB is another arbitrary system that could make the same dangerous type of overall cuts,” said Peter W. Carmel, MD, AMA president, in a statement late last month in support of the repeal legislation. “Congress should not make the same mistake again. Instead of relying on another formula that imposes across-the-board cuts that we know do not work, members of Congress should be taking steps to strengthen Medicare for patients, physicians and taxpayers.”

Even as the bill is expected to pass in the Republican-controlled House, the measure, like other bills aimed at dismantling the Affordable Care Act, will likely die in the Senate. Yet, even if the bill somehow makes it through the Senate, the Obama Administration has indicated the president will veto the bill.

A Statement of Administration Policy submitted this week in the House said: “H.R. 5 would repeal and dismantle the IPAB even before it has a chance to work. The bill would eliminate an important safeguard that, under current law, will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries and the traditional program. The Administration strongly opposes legislation that attempts to erode the important provisions of the Affordable Care Act."

But the bill may not have as smooth a ride through the House as other recent measures, largely because it is structured to pay for repeal of IPAB by capping medical malpractice award amounts.

Further, conservative groups recently expressed concern to Republican House leadership that they are opposed to the piecemeal approach to repealing health reform and should instead present legislation aimed at repealing the entire law.

In a letter to House Speaker John Boehner and House Majority Leader Eric Cantor, the heads of 16 conservative groups noted that focusing solely on IPAB “muddies the water” between people who support health reform and those who want to see it repealed.

Instead, they urge a more focused approach during this election year that will clearly define which legislators are in favor of health reform and those who oppose it.

“[Partial] repeal votes allow politicians of both parties to obfuscate on full repeal,” the letter stated. “It gives many who have consistently opposed full repeal an opportunity to convince their voters that they are with them just because they register occasional support for repealing an IPAB or some other politically unpalatable provision.”

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