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IPAB Pushback Centers on Power, Politics

 |  By Margaret@example.com  
   July 20, 2011

If you've never attended a Congressional hearing count yourself as lucky.

I spent about six hours last week watching two Congressional committees discuss the pros and cons of the Independent Payment Advisory Board. That's the controversial board created as part of the Affordable care Act and charged with recommending ways to control Medicare costs.

Congressional hearings are really just theater with committee members jawboning with selected "witnesses" who seem to espouse a preset notion of what should or should not be done on a particular issue.

And that's pretty much the way it went during two days of testimony before the Republican-led House Budget Committee and the Health Subcommittee of the House Energy and Commerce Committee. More than 15 witnesses, including HHS Secretary Kathleen Sebelius, testified ? meaning they read well-vetted statements – and answered well-planned and leading questions about the IPAB.

IPAB is the latest whipping boy for those who object to the implementation of healthcare reform. At the hearings the lines were clearly drawn primarily along partisan lines. In broad strokes, Republicans believe the board will ration healthcare, leave seniors out in the cold, and needs to be repealed. Democrats see the IPAB as a backstop or fail safe for controlling Medicare costs and preserving the program for generations to come.

Here's my take on what's happening with the battle over IPAB:

It's politics. In Washington, D.C.? What a surprise. Much of the heavy lifting on the IPAB controversy is taking place in the House where Republicans dominate. The Senate, where Democrats rule, is unlikely to take up the fight either for or against IPAB. HR 452 has been introduced to repeal the board. At last count it had 165 co-sponsors, including eight Democrats. It's a simple, one-line bill: "A bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board."

It's about power. In both committees certain members hammered away at the thought of an un-elected board of 15 people making decision about healthcare costs. If IPAB is implemented,  Congress, which has always relished its power of the purse, will find itself without a purse when it comes to Medicare. And that makes for some unhappy members of Congress.

And it's not just Congress that stands to lose power. The "I" in IPAB is for "independent."  That means some health industry stakeholders, such as health plans, hospitals, and physicians could find themselves on the outside looking in.

It's about rationing care. No it isn't. But it certainly makes a good sound bite. Sebelius has stressed again and again that ACA prohibits IPAB from rationing health care. It also can't raise Medicare revenues or premiums, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments), or restrict or reduce benefits. So what can it do?

Critics have a point when they look at this list and worry that IPAB will resort to cutting provider payments, which could mean that fewer providers will be willing to take on Medicare patients and that could limit access to care, which some members of Congress liken to rationing. Sebelius is quick to point out that while reductions in provider payments might mean that some Medicare providers would decide to no longer deliver a service "that is just like the way it works in private health insurance."

Who are these people? The president will appoint individual IPAB members who must be confirmed by the Senate and will serve six-year terms. The Affordable Care Act mentions expertise in things like health finance and economics, actuarial science, and health facility management. Among the membership requirements: employers, physicians, consumers and experts in prescription drug benefits. The president hasn't made the appointments a top priority even though the initial board funding is scheduled to kick in October 2011.

It's unnecessary. Secretary Sebelius has said that according to the CBO, the Affordable Care Act is doing such a great job reducing costs that the board probably wouldn't need to take any action for at least 10 years. She made that comment to ease the minds of opponents, but think about this: there will be 15 members making about $165,000 per year. That's $2.4 million in salaries for the board members only.

Add to that staff, rent and travel and the annual budget could easily reach $3.4 million. In 10 years that's $34 million. Actually, Sebelius is simplifying the job of the IPAB, which will need to keep up with healthcare costs, utilization numbers, patient access to care and quality issues, so it can step in when needed to make proposals to keep Medicare costs from growing out of control.

What's going to happen? HR 452 has been going nowhere fast, even with more than one-third of the House signed on as co-sponsors. It was introduced in January 2011 and referred to the House Subcommittee on Health in February where it still sits. Despite the recent hearing, the subcommittee hasn't scheduled a vote on the bill.

At one time there was a push to attach the bill to legislation raising the debt-ceiling but that seems unlikely given the way debt ceiling debate has been going. But there's still a chance that an amendment to repeal of IPAB could be attached to any number of bills. There has been some talk of reviving a version of HR 452 for the Fall when debt ceiling crisis is resolved (hopefully) and more attention can be focused on IPAB.

See Also:

Sebelius: IPAB Will Not Shift Costs or Ration Care
Controversial IPAB braces for continued battles over Medicare
Obama Deficit Reduction Plan Prompts Call for Repeal of IPAB  

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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