The Final Push for IPAB Repeal

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Congressional Republicans announced on Friday their intent to link the widely supported House bill to repeal the Medicare Independent Payment Advisory Board (IPAB) with a more partisan medical malpractice reform bill.

The IPAB repeal bill, which has been well-received thus far, and in a rare showing of bipartisanship, is co-sponsored by 20 Democrats, is expected to be voted on next week.  Linking this bill with the malpractice reform bill, which would cap noneconomic malpractice awards when a patient is injured, has almost eliminated Democratic support, as just one of the 20 Democratic co-sponsors indicated that he would still vote for the measure.

Many Democrats back IPAB repeal but oppose Republican efforts to change medical malpractice laws.  The House Republican leadership announced their intent to link the malpractice reform bill with IPAB repeal to offset what the Congressional Budget Office said would be the cost of repealing IPAB – estimated to be $3.1 billion.  Such a claim was met with skepticism from both rank-and-file Democrats and Republicans, who simply don’t believe that the costs will be that high.

Regardless of IPAB’s impact on the cost of health care, the panel is flawed, unethical, and represents the worst of health care policy reform.

IPAB, which was created with the passage of last year’s health care law, would allow an unelected board to singly enact spending cuts in the Medicare program.  Essentially, IPAB would substitute an unelected body for government, enabling it to make binding recommendations to reduce Medicare spending.

IPAB is a threat to critical medical treatments and services for all Medicare beneficiaries.  Proponents of the board have argued that IPAB will improve the quality of care as a result of the cost-cutting measures it enacts in order to save.  However, it is doubtful this will happen because the board will have to make cuts that reach annual targets, and can only look at specific parts of the health care system when making these decisions.  Thus, standard line item cuts will result, which will only reinforce systemic problems, not fix them, and create unsustainable savings.

Key Democrats, such as high-ranking members like Rep. Barney Frank (D-MA), Allyson Schwartz (D-PA), Pete Stark (D-CA), the ranking Democrat on the House Ways and Means Health Subcommittee, and Frank Pallone (D-NJ), the ranking Democrat on the House Energy and Commerce Health Subcommittee, have backed the repeal of IPAB. While they back the health law, they believe the panel would transfer power that belongs on Capitol Hill to the executive branch.

“Congress has always stepped in to strengthen Medicare’s finances when needed,” said Stark.  “I see no reason why Congress would or should hand that authority over to the executive branch. To do so undermines the separation of powers.”

Pallone voiced similar apprehensions: “For me, this is about Congressional prerogatives being limited.   IPAB, like other independent commissions, encroaches upon legislative authority.”

In addition to opposition from Republicans, Independents, and a growing number of Democrats, IPAB faces opposition from Medicare beneficiaries, providers and suppliers, and hospitals and patient care centers.  Major changes in the Medicare program should be decided by elected officials who will be held be accountable for their decisions.  Such an arbitrary system lacks transparency and oversight and gives too much power to unelected individuals.