In an effort to curtail the rise in Medicare cost, the Affordable Care Act established the Independent Payment Advisory Board (IPAB), which would consist of 15 presidentially appointed members tasked with proposing Medicare cuts if spending growth exceeded certain inflation-based projections. IPAB has been the root of a fair deal of controversy, with opponents criticizing the provision for giving too much power to “15 unelected, unaccountable bureaucrats.” Others have termed the IPAB a “death panel,” given their power over Medicare reimbursements and ability to essentially ration care.
Despite the opposition, IPAB hasn’t been an active issue because Medicare spending has not continued to rise at a high rate over the last few years. In January, Modern Healthcare reported that “[n]ews about the 15-member panel, whose members have yet to be named, quietly reappeared last week when Congress agreed to reduce $10 million in funding for IPAB in the 2014 omnibus spending bill.” The provisions for IPAB come into effect if certain per capita spending surpasses certain targets, and “Medicare spending per enrollee grew just 0.7% in 2012, even slower than the 2.5% growth rate in 2011.”
Indeed, the IPAB seemed to have been lost amidst other healthcare news—including the repeal of SGR and insertion of new quality payment metrics.
However, yesterday, over 500 organizations wrote a letter to Congress to repeal the IPAB provisions of the Affordable Care Act. The organizations wrote that they found IPAB “not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decisionmaking responsibilities and prerogatives of the Congress.”
The letter to Congress states that an unelected board without adequate oversight or accountability would be taking actions historically reserved for the public’s elected representatives in the U.S. House and Senate.
The letter notes that once in place, IPAB must achieve mandated savings within a one-year time frame. Instead of pursuing long-term reforms to strengthen Medicare, IPAB would be more likely to achieve its targets by cutting payments to healthcare providers, the letter argues
“This would be devastating for patients, affecting access to care and innovative therapies,” the groups wrote, pointing out that the number of physicians unable to accept new Medicare patients due to low reimbursement rates has been increasing. “IPAB-generated payment reductions would only increase the access difficulties faced by too many Medicare beneficiaries. Furthermore, payment reductions to Medicare providers will almost certainly result in a shifting of health costs to employers and consumers in the private sector.”
The letter concludes: “We strongly support bringing greater cost-efficiency to the Medicare program. We also advocate continuing efforts to improve the quality of care delivered to Medicare beneficiaries. The Independent Payment Advisory Board will achieve neither of these objectives and will only weaken, not strengthen, a program critical to the health and well-being of current and future beneficiaries.”
The letter echoes the American Medical Association’s (AMA) concerns with the IPAB. “While some applaud the new advisory board as a mechanism for controlling health care costs outside the influence of political processes and pressures,” AMA states, “others have criticized the scope of its authority and the lack of flexibility in its mandate.” AMA has stated that they “continue[ ] to fight for the elimination of the Independent Payment Advisory Board, which will impose arbitrary across-the-board cuts to physicians and other providers.”
Legislation to repeal the board sponsored by Reps. Phil Roe (R-Tenn.) and Linda Sánchez (D-Calif.) has 222 co-sponsors, including 19 Democrats, reports The Hill.