Congress members of both parties are directing ire against a controversial element of President Obama’s health care law, which proposes to restrain Medicare costs through the creation of the Independent Payment Advisory Board.
The IPAB is a fifteen-member body that would, beginning in 2015, submit recommendations to Congress to lower Medicare’s costs. Congress can alter these recommendations with a three-fifths vote. If it does not do so, IPAB’s recommendations will go into effect.
On a June 23 voice vote, the House Energy and Commerce Committee accepted an amendment sponsored by Rep. Charlie Bass (R-NH) to the Semi-Annual Committee Activity Report. This amendment pledges the committee to “recommend support for proposals to repeal provisions [in Obamacare] that provide an unelected fifteen member body to ration care.…” The Activity Report does not have the force of law.
Decisions Become Law Automatically
Nicole Fisher, a health care policy expert for North Carolina’s John Locke Foundation, says there are many problems with the IPAB.
“It’s an unelected, uncontrollable board. And because of the convoluted process Congress must go through to reject IPAB’s recommendations,” says Fisher, “their recommendations are basically the rule of law.”
The power given to IPAB has stirred opposition from many in Congress. Rep. Phil Roe (R-TN) has introduced legislation, HR 452, to repeal the sections of ACA that create the IPAB. This is what the Bass amendment, passed on a voice vote without any dissent from Energy and Commerce Committee members, recommends.
Few Democrats Fully on Board
Many of the members who voted for this amendment have not signed on to legislation pending in the House of Representatives that would accomplish the same thing—indicating their opposition may not have much weight behind it.
Of the 53 members of the Energy and Commerce Committee, only 22 have cosponsored HR 452. Twenty of these cosponsors are Republicans, and only two, Del. Donna Christensen of the Virgin Islands and Rep. Kathy Castor of Florida, are Democrats.
Amanda Little, a spokesperson for Rep. Roe, said he is “seeking bipartisan support” for HR 452 and that of the 161 cosponsors, 8 are Democrats.
Critics Decline to Co-Sponsor
Some Democrats are not buying the idea this legislation is bipartisan. A spokesman for Rep. Frank Pallone, a New Jersey Democrat who is a member of the Energy and Commerce Committee and has made numerous remarks against IPAB, said he will not cosponsor this legislation.
According to Pallone’s communications director, Richard McGrath, HR 452 “is being used by the GOP for political attacks on health reform.”
At a July 13 Energy and Commerce Committee hearing on IPAB, however, Pallone was unstinting in his criticism of this element of the Obamacare legislation.
“I am strongly opposed to the Independent Payment Advisory Board created under the Affordable Care Act,” said Pallone. “I’ve never supported it, and I would certainly be in favor of abolishing it.”
Other committee members expressed a more sanguine view of the Board. Energy and Commerce Committee ranking member Henry Waxman (D-CA), said at the July 13 hearing while he has “concerns about some aspects of IPAB” he doesn’t think the “hyperbole” of the IPAB critics “represents reality.”
‘Indirect Rationing’
In his testimony before the committee, Rep. Roe noted while the ACA prohibits rationing, IPAB could lead to an indirect version of the process.
“Already, Medicare only pays physicians between 85 and 90 cents on the dollar, which has made it difficult for beneficiaries to access the care they need. If reimbursement falls even further, it could very well become economically impossible for physicians to see Medicare patients.”
Fisher agrees with Roe.
“As we learned with Medicaid, the less we pay physicians, the more will leave the system,” Fisher said. “That will inevitably result in a reduction in the type of services offered and in the supply of physicians available to treat patients.”
The final disposition of IPAB is uncertain. While there is bipartisan criticism of it, the debate over its repeal is, in Fisher’s words, “very partisan.” This partisanship may prevent any united efforts to do away with the much-criticized board.
