A bipartisan bill introduced by representatives D. Phillip Roe, MD, (R-Tenn.) and Allyson Schwartz (D-Pa.) and with the support of numerous provider groups, seeks for a second time to repeal the Independent Payment Advisory Board (IPAB).
The House passed a similar measure introduced by Roe last year by a vote of 223-181, largely along party lines. That measure did not get through the Democratic-controlled Senate.
The IPAB has been a target of House Republicans and a handful of Democrats since 2010 when it was included as a provision of the Affordable Care Act. Critics of the board complain that it is an un-elected body of government bureaucrats that will be free to make cuts to the Medicare program and potentially limit seniors' access to care.
"As a physician with more than 30 years of experience, I find the ability of this board to intervene in the patient-doctor relationship particularly troubling," said Roe in a statement released with the introduction of the legislation.
The IPAB, a 15-member board appointed by the president and confirmed by the Senate, would study the Medicare program to determine if costs were exceeding targets, and if they are, the board would make recommendations to Congress on how to cut the program. No one has been named to the board yet.
Many who oppose the IPAB also say that it circumvents congressional authority to manage and legislate changes to the Medicare program.
But proponents of the IPAB see it more along the lines of the Medicare Payment Advisory Committee (MedPAC), only with teeth. MedPAC routinely makes recommendations to Congress on how it can reduce the costs or slow the overall growth of the Medicare program but the committee is purely advisory.
Opponents claim that IPAB would automatically cut the program but proponents point out that that is not the case. Congress would vote on the board's recommended cuts, either to adopt them or not. If Congress voted not to adopt them, the only way the board's cuts would be automatically adopted is if Congress is not able to craft its own legislation that equals the spending cuts needed to stay within the target spending range.
As Congressman Henry Waxman (D-Calif.) pointed out during past IPAB debates: "Congress has the final say over Medicare policy. And Congress has the final say over all IPAB recommendations."
A March 2012 brief by the Center on Budget and Policy, a Washington, D.C.-based policy research organization, noted that repealing the IPAB could be far worse than letting it become operational (which it could as early as April 30, though no one have been nominated to serve on it as yet).
"To some extent, limiting congressional micromanagement of Medicare payment policy is desirable," the brief noted. "Many times in the past, efforts to reform Medicare payments have been slowed or stopped by health-care interests that have successfully lobbied Congress to protect their income stream at Medicare's expense."
The new measure from Roe and Schwartz is backed by the American Medical Association and has the support of a number of other provider groups and organizations, including, among others, the American Hospital Association, the American College of Surgeons and the Health Leadership Council. In all, more than 350 different organizations have come out in favor of the repeal of the IPAB.
"IPAB is a panel that would have too little accountability and the power to make indiscriminate cuts that adversely affect access to health care for patients," said a statement from AMA president Jeremy Lazarus, MD. "IPAB would be another arbitrary system that relies solely on payment cuts. We must move away from these broken systems and focus on new payment and delivery models that give physicians the ability to improve patient care and reduce costs to stabilize Medicare for seniors now and in the future."