Independent Payment Advisory Board Draws New Fire From House GOP Opponents

At the opening of the first session of the 113th Congress, the House Republican leadership lost no time in registering opposition to the Independent Payment Advisory Board (IPAB) created by the health care reform law and scheduled to begin operations in 2014.

On Jan. 3, in passing procedural rules for the coming two years, the GOP leadership asserted that it can ignore any recommendations from the board. In 2012, the GOP-controlled House voted to repeal the IPAB but the Senate took no action on the bill.

The IPAB snub is symbolic since the statute’s requirements trump any rules set by congressional chambers. The battle over the board is likely to begin in the Senate since the panel’s 15 members, appointed by the president, require confirmation.

The Board’s Duties and Limits
The IPAB by law is required to make recommendations to Congress on reductions in Medicare spending, beginning in 2014, in any year when the per capita growth rate exceeds a target growth rate. Congress would have to give the recommendations fast-track consideration and they would take effect unless lawmakers approved an alternative with the requisite savings.

The law also limits the IPAB. It is barred from making any proposals that would ration care, increase Medicare beneficiary cost sharing, or otherwise restrict benefits or modify eligibility criteria.

The Congressional Budget Office has said the spending targets governing IPAB action are unlikely to be triggered until at least 2022, so the board might not make recommendations before then.

Arguments For and Against
Supporters of the IPAB say it is a fail-safe mechanism to control Medicare spending growth if Congress fails to act and it removes politics from decisions affecting Medicare providers. Opponents, including the American Medical Association and pathology and clinical laboratory groups, say the board’s unelected officials would have power over spending that historically has been reserved to Congress.

Critics also charge that since the board cannot make recommendations on restricting Medicare benefits, the savings it seeks would have to come from cutting provider payments, which in turn could threaten beneficiary access to care. In fact, hospital payments are not slated to come under the IPAB purview until at least 2020, so before then the board would have to look to clinical labs, pathologists, and other health care providers to capture savings.

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