#ObamaCare: IPAB

- March 22, 2012

A Walkthrough Of ObamaCare’s Most Powerful Bureaucracy


ObamaCare Created The Independent Payment Advisory Board (IPAB) “To Come Up With Ways To Cut Medicare Spending If It Grows Too Fast.” “That’s the job description for the 15 members of the Independent Payment Advisory Board — the new panel created by President Barack Obama’s health care law to come up with ways to cut Medicare spending if it grows too fast.” (David Nather, “Medicare Cost-Cutting Job Could Be Worst in D.C.,” Politico, 5/14/11)

  • “If Per Capita Costs Grow By More Than GDP Plus 0.5%, This Board Would Get More Power, Including An Automatic Budget Sequester To Enforce Its Rulings” To Cut Medicare Costs. “Fifteen members will serve on the Independent Payment Advisory Board, all appointed by the President and confirmed by the Senate. If per capita costs grow by more than GDP plus 0.5%, this board would get more power, including an automatic budget sequester to enforce its rulings. So 15 sages sitting in a room with the power of the purse will evidently find ways to control Medicare spending that no one has ever thought of before and that supposedly won't harm seniors' care, even as the largest cohort of the baby boom generation retires and starts to collect benefits.” (Editorial Board, “The Presidential Divider,” The Wall Street Journal, 4/14/2011)

The Wall Street Journal: IPAB Embraces The Thought That Health Care Decisions Are Best Made By Bureaucrats Rather Than Patients. “This turn is remarkable because the IPAB really does embody ObamaCare's innermost values and beliefs—to wit, that health decisions are too important to leave to the people receiving the care (patients), the people providing the care (doctors and hospitals), the people paying for the care (taxpayers), or even the people who got the government involved in the first place (politicians).” (Editorial, “Independent Payment Advisory Revolt,” The Wall Street Journal, 3/9/12)

IPAB Threatens Patient Care

Obama’s HHS Secretary Admits That IPAB Threatens Seniors’ Access To Certain Procedures. “‘If Congress accepted the recommendations and made the decision that cuts in dialysis were appropriate,’ Sebelius replied, ‘I assume there could be some providers who would decide that would not be a service they would any longer deliver...’” (Kathleen Sebelius, “IPAB:  The Controversial Consequences For Medicare And Seniors,” House Energy And Commerce Committee’s Health Subcommittee, 7/13/11)

Witnesses At A Recent Congressional Hearing Argued That IPAB Would Reduce Access To Medical Care. “The Independent Payment Advisory Board, created under the health care law to help control Medicare costs, lacks flexibility to do much more than cut provider payments that would lead to a reduction in access to care, witnesses told a House Ways and Means panel March 6.” (Ralph Lindeman, “IPAB Would Reduce Access to Care, Witnesses Tell Ways and Means Panel,” Bloomberg, 3/7/12)

The Wall Street Journal: IPAB’s “End Game” Will Limit Patient Care.” “The only alternative, and the IPAB's true end game, is harsher and more arbitrary price controls and eventually limits on the care patients are allowed to receive. The New England Journalists (of Medicine) deny this reality because ObamaCare has a clause that prohibits ‘rationing,’ even as the law leaves that term undefined. But reducing treatment options will be inevitable as government costs explode.” (Editorial, “Independent Payment Advisory Revolt,” The Wall Street Journal, 3/9/12)

  • The Wall Street Journal: IPAB Will Allow Bureaucrats To “Throw Granny Over The Cliff.”  “One place to start is by attacking the Democratic plan to cut Medicare via political rationing. Mr. Ryan's budget had the virtue of embarrassing President Obama's spend-more initial budget, and the White House responded by proposing to increase the power of the new Independent Payment Advisory Board (IPAB) to decide what, and how much, Medicare will pay for. The ObamaCare bill goes to great lengths to shelter this 15-member, unelected board from Congressional review, with the goal of letting these bureaucrats throw granny over the cliff if Medicare isn't reformed. Yet few Americans know anything about IPAB or its rationing intentions.” (Editorial, “The GOP’s New York Spanking,” The Wall Street Journal, 5/26/11)

Industry Groups Worry That IPAB’s Actions Will Result In “Rationing.” “While the board is not supposed to be able to cut benefits, industry groups fear that its actions would result in rationing care. The board … could cut payments to health care providers.” (Duff Wilson, “Industry Aims At Medicare Board,” The New York Times’ “Prescription,” 11/4/10)

Paul Howard And Douglas Holtz-Eakin: IPAB Is “Fatally Flawed,” Spurns Innovation, And Will “Threaten Seniors’ Access To Care.”  “IPAB is fatally flawed, structured to punish innovative health care providers and threaten seniors’ access to care       while leaving the largest sources of Medicare spending untouched.  It continues Washington’s obsession with price-fixing in Medicare’s separate ‘silos’ rather than changing the incentives that have led to rampant overspending, fraud and uneven care quality.” (Paul Howard & Douglas Holtz-Eakin, Op-Ed, “Repeal And Replace IPAB,” Politico, 7/12/11)


Membership To The IPAB Is Not Limited To Health Care Professionals.  “The Act requires the appointed membership of the IPAB to include individuals who enjoy ‘national recognition’ in several stated aspects of health policy, including health finance and economics, and further stipulates occupations which should be represented on the Board including physicians and ‘experts in pharmaco-economics.’ The Act specifies that the appointed IPAB members have broad geographic representation and that the Board be balanced between urban and rural representatives. In order to preclude conflicts of interest, the Act stipulates that a majority of the appointed members of the IPAB are not be persons ‘directly involved’ in the provision or management of the delivery of items and services covered by Medicare.” (Congressional Research Service, Memo To Senator Coburn, 3/18/11)

ObamaCare Gives Obama The Power To Appoint Members To IPAB During Recess.  “Because the President’s recess appointment authority is unqualified, it appears that he could fill member positions on the IPAB by recess appointment during any period when he could otherwise make such appointments. Under certain circumstances, such appointments might be subject to pay restrictions, but the analysis of such a possibility is beyond the scope of this memorandum.” (Congressional Research Service, Memo To Senator Coburn, 3/18/11)

The American Medical Association Opposes IPAB On The Ground That The Board Has Little “Accountability.” “The AMA has consistently expressed its opposition to the IPAB on several grounds.  The IPAB puts important health care payment and policy decisions in the hands of an independent body that has far too little accountability.” (James L. Madara, American Medical Association CEO, Letter To Representatives Joe Pitts, 2/27/12)


The American Medical Association Supports Repeal Of IPAB. “On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our strong support for H.R. 452, which was introduced by Representative Phil Roe, and would repeal the Independent Payment Advisory Board (IPAB).  Accordingly, we strongly support the advancement of this important legislation through the Energy and Commerce Committee.” (James L. Madara, American Medical Association CEO, Letter To Representatives Joe Pitts, 2/27/12)

  • Nearly Every Segment Of The Health Care Industry Opposes IPAB.  “An independent panel authorized by President Barack Obama’s health care law to control excessive Medicare costs increases is drawing heavy fire from Republicans.  Nearly every health industry lobbying group is pushing for its repeal, as are some consumer advocates.  GOP lawmakers call it a rationing panel, and at least one has suggested seniors will die from its decisions.” (Ricardo Alonso-Zaldivar, “Accusations Fly Over Obscure Medicare Board,” The Associated Press, 7/18/11)
    • The IPAB Is So Unpopular That 270 Health Care Groups Support Repeal.  “All told, some 270 stakeholder groups signed a letter to members of Congress urging them to repeal the Independent Payment Advisory Board. The IPAB is a panel of experts, appointed by the president, that will have the power to cut Medicare payments.” (Sam Baker, 270 Health Care Groups Back IPAB Repeal,” The Hill’s Health Watch,” 6/24/11)


The Tampa Tribune: “There Is Bipartisan Consensus … That IPAB Is A Mistake.” “There is bipartisan consensus on Capitol Hill that IPAB is a mistake. Physicians groups don't like it, hospital lobbies don't like it, and even the American Medical Association, whose support helped pass ObamaCare into law, has called for its repeal. Some Democrats, including U.S. Rep. Kathy Castor of Tampa, have signed on to Tennessee Republican U.S. Rep. Phil Roe's repeal bill.” (Editorial, “Return Control To The Patient,” The Tampa Tribune, 10/15/11)

Twenty Democrats Have Co-Sponsored Legislation To Repeal IPAB. (H.R. 452, Introduced 1/26/11)

  • Both Democrats And Republicans Agree That IPAB “Could Arbitrarily Cut Services To Medicare Patients And Payments To Providers.” “But some Democrats, as well as most Republicans and health care providers argue the panel could arbitrarily cut services to Medicare patients and payments to providers with little congressional oversight.” (Jennifer Haberkorn, “Democrats Split On Independent Payment Advisory Board,” Politico, 7/10/11)

Both The House Ways And Means And The House Energy And Commerce Committees Passed IPAB Repeal Legislation With Unanimous Bipartisan Support. “A second House committee agreed by voice vote Thursday to repeal a key cost-cutting board in President Obama’s healthcare law. The Ways and Means Committee voted to repeal the Independent Payment Advisory Board (IPAB), a 15-member panel tasked with cutting Medicare payments. The Energy and Commerce Committee passed the same repeal bill earlier this week.” (Sam Baker, “Second House Panel Clears Bill To Repeal Medicare Board,” The Hill’s Health Watch,” 3/8/12)

Rep. Pete Stark, (D-CA): Setting Low Payment Rates “Could Endanger Patient Care.” “But, in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care.” (Robert Pear, “Obama Panel to Curb Medicare Finds Foes In Both Parties,” The New York Times, 5/19/11)

  • Rep. Pete Stark (D-CA): IPAB Is A “Mindless Rate Cutting Machine … That Will Endanger The Health Of America’s Seniors And People With Disabilities.” “I oppose the inclusion the Independent Payment Advisory Commission, called IPAB.  Some of my colleagues support this Commission because it shields them from having to take tough votes when it comes to cutting Medicare provider payments. It’s my experience that Congress always does what is needed to protect and strengthen the Medicare program.  IPAB is a dangerous provision.   By statute, this Commission would be required to hold Medicare spending to an arbitrary and unrealistic growth rate.  It is a mindless-rate cutting machine that sets the program up for unsustainable cuts. That will endanger the health of America’s seniors and people with disabilities.  It is an unprecedented abrogation of Congressional authority to an unelected, unaccountable body of so-called experts.  I intend to work tirelessly to mitigate the damage that will be caused by IPAB.” (“Statement of Congressman Pete Stark Supporting Health Care Reform,” Office of Rep. Pete Stark, 3/21/10)

Rep. Allyson Schwartz (D-PA) Says IPAB “Could Lead To Arbitrary Cuts To Doctors, Hospitals And Other Providers.” “In fact, Schwartz will be one of the GOP’s star witnesses at the Energy and Commerce Committee hearing. She says IPAB puts Congress’s responsibility in the hands of an outside panel and could lead to arbitrary cuts to doctors, hospitals and other providers.” (Jennifer Haberkorn, “Democrats Split On Independent Payment Advisory Board,” Politico, 7/10/11)

Rep. Frank Pallone (D-NJ) Says He Strongly Opposes IPAB And It Must Be Stopped. “I am very strongly opposed to the Independent Payment Advisory Board, or IPAB, created under the Affordable Care Act. I’ve never supported it and I would certainly be in favor of abolishing it…It’s not the job of an independent commission to get involved in congressional matters, in this instance, healthcare policies for Medicare beneficiaries…It’s about a growing, imperialistic presidency…We have to stop it. We have to reverse it. We can’t be a part of an effort to let that continue.” (Committee On Energy And Commerce, U.S. House, Hearing, 7/13/11)

Rep. Lois Capps (D-CA) “Favors Getting Rid” Of IPAB But Voted Against Repeal Due To No Alternatives Being Offered. “And Rep. Lois Capps (D-Calif.) said she favors getting rid of the board but wouldn’t because the repeal bill offered no alternative for controlling Medicare costs and wasn’t paid for.” (Julian Pecquet, “House Panel Repeals Health Law’s Cost-Cutting Board With Bipartisan Support,” The Hill’s “Health Watch,” 2/29/12)

Former Democrat House Majority Leader Dick Gephardt:  IPAB’s Cuts Will Cause “Devastating Consequences.” “It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar. Just as important, these cuts are likely to have devastating consequences for the seniors and disabled Americans who are Medicare's beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.” (Dick Gephardt, Op-Ed, “Medicare Must Remain A Responsibility Of Congress,” Huffington Post, 6/21/11)


The White House: “H.R. 5 would repeal and dismantle the IPAB even before it has a chance to work. … The Administration strongly opposes legislation that attempts to erode the important provisions of the Affordable Care Act. … If the President is presented with H.R. 5, his senior advisors would recommend that he veto the bill.” (Statement Of Administration Policy, H.R. 5 – Protecting Access To Health Care Act, Executive Office Of The President, 3/20/12)

Which Is Not Surprising Since Obama Has Recently Called For Strengthening IPAB

Obama Has Continually Pushed For Strengthening IPAB Through His Deficit Reduction Plan. “The plan calls for strengthening a controversial piece of the healthcare reform law, and it includes proposals state governments have strongly opposed. It also would require seniors to pay more for certain Medicare benefits, according to a summary of the proposal, which would cut $248 billion in Medicare funding and $73 billion to Medicaid and other health programs.” (Sam Baker, “Obama Health Cuts To Spark Fights With States, GOP, Industry Groups,” The Hill’s Health Watch,” 9/19/11)

  • IPAB Will “Kick In” Earlier According To Obama’s Deficit Reduction Plan. “The plan proposes strengthening the Independent Payment Advisory Board (IPAB) — a cost-cutting panel created by healthcare reform that Republicans have said will ‘ration’ care. Obama’s proposal would allow the IPAB to kick in earlier.” (Sam Baker, “Obama Health Cuts To Spark Fights With States, GOP, Industry Groups,” The Hill’s Health Watch,” 9/19/11)

Obama’s 2013 Budget: “Strengthen the Independent Payment Advisory Board (IPAB) to Reduce Long-Term Drivers of Medicare Cost Growth.” (OMB, 2/13/12)

  • Obama's Budget Lowers The Threshold For IPAB To Make Payment Changes To Medicare And Provides IPAB With "Additional Tools" To Control Spending. "To further moderate the rate of Medicare growth, this pro­posal would lower the target rate from the GDP per capita growth rate plus 1 percent to plus 0.5 percent. Additionally, the proposal would give IPAB additional tools like the ability to consider value-based benefit design." (OMB, 2/13/12)

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