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IPAB Pushback Centers on Power, Politics

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

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.

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