The Impending IPAB Deadline

After the new Congress takes its oath of office in January, it will have no shortage of big issues on its plate.  Among them should be a reconsideration of the Independent Payment Advisory Board (IPAB).

To recap, IPAB is a key component of the Patient Protection and Affordable Care Act.  It is a board of political appointees (no one has yet been nominated to serve on IPAB, it should be noted) that would make recommendations on reducing Medicare spending if the Medicare Chief Actuary determines that the program’s per capita growth rate will exceed arbitrary spending limits.  Unless Congress overturns the IPAB recommendations with a three-fifths vote in the Senate or approves an alternative that achieves the same level of savings, the proposals made by this unelected board will have the power of law and would not be subject to judicial review.

There is a superb article on IPAB published this month in the American Medical News that details exactly how the IPAB process would work and the dangers it poses to healthcare access and quality by making cuts in what Medicare pays for goods and services without regard to elevating the program’s value to beneficiaries and taxpayers.

This year, the House has voted to repeal IPAB, with bipartisan support, but the Senate has not allowed the measure to come to a vote.

In the past year, there was not a sense of congressional urgency surrounding this issue because IPAB was still seen more as concept than reality.   That won’t be the case in 2013.  According to the law, the Chief Actuary must determine by April 30 if projected spending will exceed per capita limits and then IPAB members must submit their spending control proposal by September 1.

There are serious arguments to be made about whether IPAB represents a transfer of power to unelected individuals that the framers of the Constitution never envisioned or would have allowed.  There are equally important arguments that IPAB will do serious harm to Medicare beneficiaries when lawmakers should pursue better alternatives that will actually enhance program value and care quality.

As the timetable tells us, Congress needs to consider those arguments with a certain degree of urgency when the calendar turns to 2013.