Bipartisan Legislation to Repeal Independent Payment Advisory Board Introduced in the House
March 16, 2015 01:06 PM
Last week Congressman Phil Roe (R-TN) and Congresswoman Linda Sánchez (D-CA), along with over 200 bipartisan original cosponsors, introduced the Protecting Seniors’ Access to Medicare Act (H.R. 1190), which would repeal the Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA). The IPAB has faced widespread opposition from a variety of health care organizations, including The National Association for Home Care & Hospice (NAHC), due to concerns that it would limit access to care for Medicare beneficiaries, shift costs to consumers, and usurp the authority of Congress.
With the introduction of the House bill, versions of the legislation repealing the IPAB have been filed in both chambers of Congress. Senator John Cornyn (R-TX) in January introduced a Senate version, S. 141, which has 37 cosponsors.
Congressman Roe had also sponsored the bill last Congress when the effort ultimately received 227 bipartisan cosponsors. “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,” Roe said about identical legislation last Congress. “I believe my bill is a testament to the fact that members of Congress can put party politics aside, come together and do what’s right for our seniors. I will continue to push for a full repeal of the IPAB, and I look forward to working with my colleagues—both Republicans and Democrats—to protect and preserve Medicare.”
While Congresswoman Sánchez had not previously been the lead Democratic sponsor of the bill, she has long opposed the IPAB and had cosponsored the legislation in the past. At the time Congress passed the PPACA, Sanchez supported the underlying bill but raised concerns specifically about the IPAB provision. “Without doubt, this is not a perfect bill,” Sánchezsaid in 2010 when announcing her support for the PPACA. “It [the PPACA] contains an Independent Payment Advisory Board, which would severely limit Congressional oversight of the Medicare program and place authority within the executive branch, without Congressional oversight, judicial review, or state or community input… Just about every bill can be improved in one way or another.”
The IPAB provision of the PPACA (P.L. 111-148) created a board of presidential appointees with the power to make recommendations to cut Medicare if expenditures reach a certain level. The actions by the IPAB would be subject to little oversight, and the provision prohibits judicial review once the Secretary of Health and Human Services implements an IPAB recommendation.
While proponents of the IPAB claim it could result in health care delivery reforms, a requirement in the provision that IPAB must achieve savings within one year would force the IPAB to focus on short-term payment cuts to providers rather than long-term reforms. According to an issue brief by the Kaiser Family Foundation, the requirement to achieve Medicare savings in the implementation year “may discourage the type of longer-term policy change that could be most important for Medicare and the underlying growth in health care costs, including delivery reforms.” Instead, “the IPAB may be more likely to consider more predictable, short-term scoreable savings, such as reductions in payment updates for certain providers.”
In addition to the concerns about harming access and cost-shifting, NAHC has objected that the authority granted to the board should belong of Congress. It would be unprecedented for an unelected board to have the authority to put forth reductions to Medicare, rather than Congress considering such changes. The democratically elected members of Congress should have the authority to debate and make changes to Medicare, which is a public program upon which millions of seniors and disabled persons rely. By usurping the authority of Congress, the provision also limits the power of citizens to petition Congress and meaningfully participate in the lawmaking process.
NAHC has called for repeal of the IPAB as part of its Legislative Blueprint for Action. Please stay tuned to for further details and NAHC Action Alerts on this effort.