Pro/con: Should Congress keep the Independent Payment Advisory Board?
There is no question that Medicare must be improved to provide better health benefits to seniors at lower costs. But Congress is abdicating its constitutional responsibility by giving a panel of 15 unelected technocrats the power to cut Medicare ...
There is no question that Medicare must be improved to provide better health benefits to seniors at lower costs. But Congress is abdicating its constitutional responsibility by giving a panel of 15 unelected technocrats the power to cut Medicare spending and make decisions that will only result in rationing of care.
The Independent Payment Advisory Board was created as part of the new health law to guarantee that Medicare stays within a strict budget. The IPAB received little attention before the law passed, but opposition is growing inside and outside Congress.
IPAB stands for everything that is wrong with the Affordable Care Act -- taking power away from doctors and patients and putting it in the hands of elite experts who have virtually no accountability to patients or voters.
Rep. Frank Pallone, D-N.J., the top Democrat on the Energy and Commerce Health Subcommittee that oversees Medicare, said he has no interest in defending the board. "I've never supported it, and I would certainly be in favor of abolishing it," he said.
Even the Obama administration is offering a weak defense. Health, Education and Welfare Secretary Kathleen Sebelius was recently called before two House committees investigating the board. She insisted the IPAB is simply a "backstop" that shouldn't be needed if Congress does its job in keeping Medicare spending under control. Then she went on the attack against Republicans, criticizing their plans for Medicare reform -- which would start in 2022.
This is an audacious position since Sebelius is presiding over Affordable Care Act, which takes $575 billion out of Medicare -- starting now -- to create two shockingly expensive new entitlement programs and creates the all-powerful IPAB whose rulings will quickly dry up access to care for seniors.
The government approach to holding down Medicare spending traditionally defaults to making deeper and deeper reductions in payment rates to providers rather than implementing reforms that reward innovation.
The IPAB is true to form. Despite claims from its supporters that the board could encourage innovation, it must meet short-term budget targets and its primary tool will be cutting payments to providers.
Even before the board's cuts begin, Medicare is on track to pay doctors and hospitals so little that it will lead to "severe problems with beneficiary access to care," according to Medicare actuaries.
And President Obama wants to double-down on IPAB's powers, giving the board authority to cut payments to doctors even more deeply and giving the board power to "sequester" congressional appropriations if Congress tries to overrule its cuts.
The IPAB clearly is not the right solution to holding down Medicare cost. Instead, Congress must accept responsibility and institute policies that will allow innovation, competition and beneficiary choice to modernize Medicare and improve it for a new generation of seniors.
Grace-Marie Turner is president and founder of the Galen Institute, which is funded in part by the pharmaceutical and medical industries.