The Independent Payment Advisory Board, a controversial body with a $15 million budget but not a single elected member, continues to generate discord in Washington. Kathleen Sebelius, Secretary of Health and Human Services, spent several hours over two days this week defending the board before two House committees.
Mandated by the Affordable Care Act to go into effect by 2014, IPAB has been decried by physicians groups such as the American Medical Association and the American Hospital Association. The board will be a 15-members panel of doctors, nurses, medical experts, and consumers who recommend ways to reduce healthcare spending.
But Republicans and some Democrats support repeal of the board, which will have the power to analyze the drivers of Medicare cost growth and then recommend to Congress policies to reduce that growth. At least one bill, HR 452, has been introduced to repeal the boars.
The two days of testimony before the Republican-led House Budget Committee on Tuesday and health subcommittee of the House Energy and Commerce Committee on Wednesday included Sebelius and more than 15 witnesses representing consumer advocates, policy analysts, attorneys and physicians.
The testimony and questions touched on some common themes: the power of the IPAB, the effect of decreased provider payments on patient access, and the definition of rationing. Although the IPAB was the focus of the hearings, the participants often took the opportunity to tout or pan the Republican plan to redesign Medicare.
In an acrimonious appearance before the House Budget Committee Sebelius drew sharp contrasts between the Republican plan for Medicare and the IPAB. "The Independent Patient Advisory Board makes recommendations to Congress," she said. "It is forbidden by law to do exactly what the Republican budget plan does. It may not shift costs to seniors and it may not change benefits."
Committee Chairman Paul Ryan (R-WI), the chief architect of the Republican budget plan, which is often referred to as the Ryan plan, pressed Sebelius to explain how unilateral decision making by "this board of 15 unelected officials whose decisions can only be overturned by a supermajority in Congress" could possibly be the best way control healthcare costs.
Noting IPAB's initial $15 million budget Ryan said, "I just don't think we should invest all of this money and power in the decisions of 15 people versus giving beneficiaries a choice of how they want to spend their healthcare dollars."
Sebelius responded that the Republican plan to provide premium support to Medicare beneficiaries "is nothing but cost-shifting that has no plan for the delivery of healthcare and doesn't save a penny."
Republicans on both committees expressed concerns about the composition of the IPAB. Sebelius explained that the members will be appointed by the president with confirmation by the Senate. Their salaries will be about $165,000 annually. President Obama hasn't nominated any members yet, but Sebelius said she expects the IPAB to be active by 2014 as required by the ACA.
Rep. Ryan stated that IPAB was effectively unaccountable because its decisions would be almost impossible for Congress to reject or modify. "If IPAB proposes a change in provider payments and Congress doesn't agree with that recommendation, by law our only recourse is to develop another proposal that will save an equal amount of money."
Sebelius noted that while IPAB was tasked by law with "preserving the future of Medicare by making proposals to hold down costs" it would only make proposals if Medicare spending was growing too quickly based on the GDP. She cited a CBO study that projected IPAB would not need to take any action for at least 10 years.
At Wednesday's meeting of the health subcommittee of the House Energy and Commerce Committee Sebelius fielded question after question about the possibility of IPAB reducing provider payments that could result in rationing of services.
"If IPAB decides to reduce provide payments for dialysis is it possible that some providers will stop offering dialysis?" asked subcommittee chairman Joe Pitts (R-Penn). "And won't that limit patient access? That's rationing."
Sebelius explained that IPAB is forbidden by law from taking any steps that would reduce or eliminate services. "IPAB can't ration care." She said reductions in provider payments might mean that some Medicare providers would decide to no longer deliver a service but noted that is just like the way it works in private health insurance.
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Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
