The term “unelected bureaucrats” has been bandied about in Congress when referring to a particularly loathsome provision – to some – of the Affordable Care Act: the Independent Payment Advisory Board (IPAB). The reference is to the 15 people who will serve on IPAB, all of whom are subject to Senate confirmation.
In simple terms, the IPAB’s role is to suggest cuts to Medicare if the program’s spending exceeds certain thresholds. The HHS Secretary would then be required to enact those spending reductions, but only if Congress does not pass its own legislation to get Medicare spending within the target. Seems simple, right?
Not quite. In late March, the House held yet another symbolic vote to abolish IPAB. All the Republicans and seven democrats voted for the measure, leaving it to die in the Senate.
More than a few Democrats are also opposed to the IPAB. While only seven crossed the aisle in the recent House vote, there would have been many more had the Republican leadership not also included in the same bill new medical malpractice regulations that would have capped, for instance, pain and suffering awards to no more than $250,000.
Democrats’ opposition to the board is significantly different. While Republicans reactively oppose virtually anything tied to health reform, Democrats believe that the presence of the IPAB would circumvent their legislative authority to fund and manage the Medicare program.
Rep. Bill Pascrell (D – NJ), who didn’t vote for repeal of the IPAB due to the malpractice provisions of the bill, nonetheless issued a statement on the day of the vote that echoes the thoughts of many Democratic colleagues.
“I have concerns with IPAB, including how it will operate and that it gives up important Congressional authority over pricing,” the statement read. “Abdicating our responsibility is not the right thing to do for our seniors. I was elected by my constituents to protect Medicare.”
It is a spectacularly ironic statement given the repeated failures of Congress to progressively manage the runaway spending of the program. Perhaps Congress is afraid of another Medicare debacle like the sustainable growth rate (SGR) provision passed at the very beginning of Bill Clinton’s second term that was designed to curb spending in the program.
Fair enough, but that does not recognize the vast differences between IPAB and SGR, the most notable being that SGR spending cuts are determined by a mathematical formula; the IPAB spending cuts would be generated by people.
But perhaps more to the point, it is almost laughable to have members of Congress take umbrage at not being able to act in the best interest of the Medicare program, when for the past 15 years since the SGR went into effect, Congress has repeatedly failed to act in the best interest of the Medicare program. It’s not a state secret that each year SGR is left in place, it costs more to fix and yet not once have enough members of Congress found the political will to do the right thing and pass the so-called 'doc fix.'
The IPAB was actually created in part in recognition that our national legislators simply do not have the political will to make the hard choices that may be needed to rein in Medicare spending. In the future, the IPAB could provide political cover to politicians who lack the gumption to take a stand on Medicare spending reductions. So I find it hard to understand why so many oppose it.
After all, if members of Congress don’t like the IPAB they only have themselves to blame.