It's no secret that the Republicans who swept into power in the 2010 elections are intent on defunding and dismantling, piece by piece, the Affordable Care Act. The latest portion of the ACA to come under fire – somewhat obscured by the wrangling over the country's debt ceiling – is a cornerstone of the law meant to keep Medicare spending in check, the Independent Payment Advisory Board (IPAB).
Some have likened the IPAB to the Base Realignment and Closure Commission, an independent panel created in the late 1980s under the Reagan Administration and tasked with making the hard recommendations to Congress on which military bases should be closed. It's a simple idea meant to remove politicking from the process and allow an independent panel to make specific cost control recommendations to Congress.
But opposition to the IPAB has been mounting – not just from Congressional leaders, but also from a host of organizations in the medical community.
"The AMA opposes any provision that would empower an independent commission, such as the IPAB, to mandate payment cuts for physicians. Physicians are already subject to an expenditure target and other potential payment reductions as the result of the Medicare physician payment formula," wrote American Medical Association President Cecil Wilson in a January 2010 letter to Senate Majority Leader Harry Reid (D-Nev.).
While the AMA is reluctant to be subjected to yet another strict payment cap given the ongoing SGR payment formula debacle, it's curious that the organization should tout Congress as the ultimate arbiter – the same Congress that, for more than a decade, has shrunk from the challenge of fixing the SGR.
What really scares many in the medical community though is that the IPAB – unlike the Medicare Payment Advisory Commission (MedPAC), whose recommendations Congress routinely ignores – will have real power in shaping Medicare payment policy. If Congress doesn't act on its recommendations, it would be up to the Department of Health and Human Services to implement them.
In recent testimony before the Energy & Commerce Subcommittee on Health, Mary Grealy, president of the Healthcare Leadership Council, argued that the IPAB would create healthcare access problems for seniors and provide the 15-member panel with far too much power in setting Medicare policy.
HHS Secretary Kathleen Sebelius defended the IPAB and downplayed the assertion that power was being taken away from Congress to craft Medicare payment policy.
"The IPAB recommendations are only implemented when excessive spending is not addressed and no other actions are taken to bring spending in line," she said.
With the House expected to begin action after the August recess on an IPAB repeal bill sponsored by Rep. Phil Roe (R-Tenn.), opponents of the IPAB will need to walk a fine line between arguing that it will have too much power and making the broader contention that the IPAB's recommendations will have the ultimate effect of rationing care to seniors for the measure to have any chance of passing both chambers.