Bill to Repeal IPAB Gaining Momentum

May 11, 2015

Now that Congress has slain the dragon called the sustainable growth rate (SGR) formula, momentum is building to repeal yet another Medicare cost-control mechanism that is loathed by most of organized medicine: the Independent Payment Advisory Board (IPAB).

There are now enough votes in the House to pass a bill striking down this board, created by the Affordable Care Act (ACA).

The IPAB's job is to give Congress recommendations on how to slow the growth of Medicare spending if it exceeds certain thresholds. The ACA's language makes it hard for Congress not to enact IPAB proposals, and if lawmakers fail to do so, the US Department of Health and Human Services is required to implement them.

Republicans and many medical societies view the IPAB as a collection of unaccountable bureaucrats who will ration care and cut physician reimbursement just as the SGR formula threatened to do. Some political conservatives go so far as to call the IPAB a "death panel," even though the law explicitly prohibits the board from proposing anything that would ration healthcare or restrict benefits. IPAB backers say the board will be more effective in controlling Medicare spending than a Congress under the spell of industry lobbyists.

Rep. Phil Roe, MD (R-TN), cochair of the GOP Doctors Caucus, has offered up legislation to repeal the IPAB going back to 2011. In one respect, this opposition is preemptive. Since the ACA's passage, the growth of Medicare spending has slowed down without the IPAB. The Congressional Budget Office last year projected that future spending growth wouldn't trigger IPAB intervention through 2023, the last year in its forecast. President Barack Obama has yet to nominate anyone to the 15-member board, and it is unlikely the Senate would confirm their appointment if he did.

Nevertheless, Dr Roe is taking no chances. Last week he announced that his latest IPAB repeal bill, titled the Protecting Seniors' Access to Medicare Act of 2015, had 222 cosponsors, including him. That means the bill has surpassed the threshold of 218 votes needed for House approval. Nineteen of the cosponsors are Democrats, including Rep. Linda Sanchez (D-CA), the other principal sponsor.

The Senate is considering an identical measure sponsored by Sen. John Cornyn (R-TX), which has 38 cosponsors so far.

Just to make sure Congress is listening, more than 500 groups, including the American Medical Association and other major medical societies, sent lawmakers a letter last week urging them to repeal the IPAB. The letter said the board not only threatens beneficiaries' access to medical care but also infringes "upon the decision-making responsibilities and prerogatives of Congress."

Other signatories in this truly diverse coalition included pharmaceutical companies such as Merck and Eli Lilly, disease groups such as the Arthritis Foundation and the Michigan Lupus Foundation, a Tea Party group in Alabama called Rainy Day Patriots, the Latino Commission on AIDS, the Vietnam Veterans of America, and the Montana Manufacturing Council.


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