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IPAB Pushback Centers on Power, Politics

Margaret Dick Tocknell, for HealthLeaders Media, July 20, 2011

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?

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