AGA Washington Insider

A policy blog for GIs

IPAB Repeal Legislation Continues to Gain Supporters

The Patient Protection and Affordable Care Act (PPACA) created the Independent Payment Advisory Board (IPAB) whose sole responsibility is to make global recommendations on Medicare spending if spending exceeds the gross domestic product plus 1 percent. This unelected, unaccountable body would be appointed by the president and subject to Senate confirmation, and would usurp congressional authority not only over Medicare spending, but policy. This unprecedented power has never been granted to an independent government entity argue David V. Rivlin, Jr., and Elizabeth P. Foley in the recent Wall Street Journal piece, “An ObamaCare Board Answerable to No One.” The authors argue that the IPAB is unconstitutional because of its unaccountability to the people while making health-care policy decisions that will impact them.

The IPAB was an initiative that originated in the Senate during the health-care reform debate and was supported by Sen. Jay Rockefeller, D-WV, and then OMB Director Peter Orzag. The House of Representatives did not include such a provision in their version of health-care reform and in fact, many liberal Democrats like former Rep. Pete Stark, D-CA, opposed it since it took away Congress’ authority over Medicare policy decisions. The provision remained in the final bill that passed Congress to appease Senate Democrats who had concerns over whether the bill did enough to control health-care spending. The AGA, along with most of the physician community and other providers, opposed IPAB during the health-care reform debate and have continued to urge that Congress repeal it.

Legislation has been introduced in both the House and the Senate, H.R. 351/S. 351, the Protecting Seniors Access to Care Act, that would repeal IPAB. The legislation currently has 186 cosponsors in the House — even a few House Democrats — and 35 cosponsors in the Senate. The Senate bill has one Democratic cosponsor, Sen. Mark Pryor, D-AK, which is one more than the bill had in the last Congress.

The AGA supports H.R. 351 since physicians would be subject to the brunt of the IPAB’s policy decisions. The bill, introduced by physician Rep. Phil Roe, R-TN, stipulates that hospitals and nursing homes are not subject to the IPAB until 2021 and the IPAB can not increase premiums on beneficiaries or ration care. Rivlin and Foley argue that “reducing payments to doctors, hospitals and other health-care providers may cause them to limit or stop accepting Medicare patients, or even to close shop.”

The AGA and the physician community continue to advocate that Congress vote to pass the IPAB repeal legislation especially given the instability of the current Medicare physician payment system. Imposing IPAB on physicians would subject physicians to double jeopardy. Like Rivlin and Foley, the AGA and the physician community urge Congress to repeal IPAB or at least defund its implementation. Contact your legislator to encourage them to pass the IPAB repeal legislation.

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