House Committee Votes to Repeal IPAB

The end may be near for the Independent Payment and Advisory Board.

In a voice vote the full House Energy and Commerce Committee voted Tuesday morning to approve the Medicare Decisions Accountability Act (HR 452). The bill's passage sets the stage for a potential House vote to repeal the IPAB.

The committee wasted no time, with the vote coming within 10 minutes of the start of the hearing. Rep. Fred Upton (R-MI) presented an amendment to the two-page bill to clarify a procedural issue. Rep. Henry Waxman (D-CA) entered statements in support of IPAB from the AFL-CIO and Department of Health and Human Services Secretary Kathleen Sebelius, among others, into the public record.

Democrats seemed resigned to the vote's outcome. There were no objections to the voice vote and no opposition votes were noted. HR 452 has 232 co-sponsors, including 17 Democrats.

Created as part of the Patient Protection and Affordable Care Act, the 15-member IPAB board is empowered to analyze the drivers of Medicare cost growth and then to recommend to Congress policies to control those costs, if spending exceeds a targeted growth rate. IPAB recommendations are to be put in place unless Congress votes to block them and comes up with equivalent cost-cutting measures.

IPAB has been the subject of numerous House committee meetings as Republicans and some Democrats have challenged the board's standing. At the bill's mark up session held late Monday afternoon, objections touched on familiar themes: the power of the unelected board, rationing, and access to care.

Rep. Steve Scalise (R-LA) stated that the board, which would be appointed by the president and approved by the Senate, would put "15 unelected bureaucrats…literally in the middle of decisions between doctors and patients."

Rep. Gregg Harper (R-MS) cautioned that IPAB would "rob Congress of its governing authority. It is an unprecedented power grab." Rep. Michael Burgess (R-TX), who is a physician, noted that since hospitals are exempt from cuts until 2018, IPAB would have little flexibility but to reduce physician payments, which would "result in fewer physicians participating in the Medicare program. That sounds like rationing."

Rep. John Dingell (D-MI) questioned why with all the talk of cutting costs Republicans were determined to eliminate an important board that held the promise of reducing healthcare spending. "This strikes me as particularly curious and dubious," he said.

Rep. Frank Pallone Jr. (D-NJ)  said he supports IPAB's repeal because Congress shouldn't cede its governing power to regulatory boards. However, he said he supports healthcare reform and cautioned that Republicans shouldn't interpret his support of HR 452 as anything more than a simple objection to IPAB.

The committee vote was heralded by Republicans in tweets and formal statements. "IPAB was created by the health care law and has drawn widespread bipartisan opposition because it threatens to reduce seniors' access to treatments and services in Medicare," said Rep. Upton in a press statement announcing the vote.

Rep. Phil Gingrey (R-GA), who supports the repeal touched on a common objection in his tweet: "unelected bureaucrats shouldn't come between patients and their doctors."

Rep. Marsha Blackburn's (R-TN) tweet seemed to confirm a common concern of Democrats that Republicans still hope to repeal the healthcare reform. "Happy to report the repeal of the IPAB passed out of House Commerce," tweeted Blackburn. "We're closer to repealing President Obama's flawed healthcare law."

While the House Energy and Commerce vote was taking place, the House Ways & Means Committee held a hearing on to discuss IPAB's potential influence on Medicare. The committee is scheduled to mark up HR 452 on Thursday. The full House may consider the bill next week.

Support for an IPAB repeal remains iffy on the Senate side. Sen. John Cornyn (R-TX) introduced in February the Healthcare Bureaucrats Elimination Act (S 2118). The bill has 22 Republican co-sponsors and no Democratic co-sponsors.

Unless that changes, the bill will probably go nowhere.