WASHINGTON, March 19 (LID) – Legislation is advancing in the U.S. House of Representatives to disband the Medicare Independent Payment Advisory Board (IPAB) that was created by the controversial 2010 federal health care law.
Sections 3403 and 10320 of the Patient Protection and Affordable Care Act (PPACA, Pub. L. 111–148) tasks the 15-member board, beginning in 2014, with reducing government expenditures on Medicare without affecting coverage or quality of care to beneficiaries.
The American Medical Association has been a vocal opponent of IPAB powers, saying the board would have broad discretionary authority.
Legislation to repeal IPAB is sponsored by physician Rep. Phil Roe (R-Tenn.). His H.R. 452, the Medicare Decisions Accountability Act, is co-sponsored by 234 House members, including at least 20 Democrats.
The Republican-led House is expected to pass H.R. 452, which passed the House Ways and Means Subcommittee on Health on March 8. The House Energy and Commerce Committee approved the proposal two days earlier.
Roe said IPAB has two “significant structural problems”—it’s both “unaccountable and unworkable.”
He said the board is empowered to make recommendations without any input from Congress.
“Don’t just take my word for it – President Obama’s former Budget Director Peter Orszag has called IPAB the ‘single biggest yielding of power to an independent entity since the creation of the Federal Reserve,’” Roe said in a statement.
IPAB was envisioned as a strengthened alternative to the Medicare Payment Advisory Commission (MedPAC), an advisory panel that lacks regulatory powers.
Under PPACA, IPAB will develop a proposal to reduce Medicare spending to bring spending in line with target, per capita growth rates set by the chief actuary of the federal Centers for Medicare and Medicaid Services (CMS).
The board would submit a proposal in January of the year before the implementation year. The secretary of the Department of Health and Human Services (HHS) would implement the IPAB proposal baring congressional action.
PPACA outlines that IPAB should not make proposals to ration care, raise Medicare premiums, increase cost-sharing or modify Medicare eligibility criteria.
The American Medical Association said the physicians’ group opposes an independent commission that could mandate reduced Medicare reimbursement rates to providers. IPAB recommendations should require congressional approval, the group has argued.
Reductions of federal budget deficits and control of Medicare spending growth “can best be achieved by Congress working in a bipartisan manner to reform the delivery system and improve quality, access and efficiency,” AMA President Dr. Peter Carmel wrote in a Feb. 27 letter to lawmakers.
Meanwhile, the progressive Washington-based Center for American Progress (CAP) on March 5 released a study that jettisoning PPACA’s IPAB provisions would increase federal deficits and the national debt.
“If the Independent Payment Advisory Board is repealed or hamstrung the only alternative would be to ration care by privatizing Medicare, shifting costs to beneficiaries, and restricting eligibility,” according to the CAP analysis, The Independent Payment Advisory Board: Protecting Medicare Beneficiaries and Taxpayers from Special Interests.”
Among Democrats backing IPAB repeal: Rep. Barney Frank (D-Mass.), Allyson Schwartz (D-Pa.), Pete Stark (D-Calif.), the ranking Democrat on the House Ways and Means Health Subcommittee, and Frank Pallone (D-NJ), the ranking Democrat on the House Energy and Commerce Health Subcommittee.
But Democratic support could be eroded by reported GOP plans to link Roe’s repeal bill with separate legislation sponsored by Rep. Phil Gingrey (R-Ga.) that seeks to cap noneconomic awards in medical maklpractice cases.
The text of H.R. 452, the Medicare Decisions Accountability Act, is available at http://www.gpo.gov/fdsys/pkg/BILLS-112hr452rh/pdf/BILLS-112hr452rh.pdf.