NPR’s Morning Edition reported on the opposition to the Medicare Independent Payment Advisory Board (IPAB) from Republicans and a growing number of Democrats. The problems with the IPAB in the Senate version of the Affordable Care Act were one of the reasons that the original House version of the bill was preferable. Some House Democrats who never supported this structure of the IPAB which eventually passed are now supporting repeal of the board.
Morning Edition reports that Republicans have been attacking the IPAB with their usual hyperbole while Democrats have had more reasoned criticism:
Democrats don’t use such hyperbole, but more than half a dozen have signed on as cosponsors of a bill that would repeal the board. And many more, particularly Democrats in the House, never supported creating the board in the first place.
What the law actually calls for is a board of 15 health experts, to be appointed by the president and confirmed by the Senate. Their task is to make recommendations for ways to reduce Medicare payments without cutting benefits or increasing costs to Medicare beneficiaries.
That’s not much different from an existing panel of expert Medicare advisers, the Medicare Payment Advisory Commission, or MedPAC. Except for one thing. Congress is free to ignore MedPAC’s recommendations. And it does, routinely.
That won’t be the case with the new IPAB. Its recommendations will take effect unless both houses of Congress override them with a two-thirds vote. Republicans – and more than a few Democrats – find that excessive.
“Even if the Congress could muster up, both the House and the Senate, a two-thirds vote, which is virtually impossible, but in the remote possibility that we could; we would have to find cuts somewhere else other than what they recommended in the Medicare program, said Rep. Phil Gingrey (R-GA), co-chair of the GOP Doctors Caucus.
Jay Rockefeller, who supports the IPAB, argues:
You want to have the Gail Wilenskys…and the Bruce Vladecks,” he said, referring to former heads of the agency that runs Medicare. “People who have broad health care policy experience making those decisions.”
Yes, listen to Gail Wilensky and Bruce Vladeck. Both oppose the IPAB as structured in the Senate version of the Affordable Care Act which became law:
Both Wilensky and Vladeck – the former a Republican and the latter a Democrat — think the IPAB is a bad idea.
Wilensky, who oversaw Medicare for the first President Bush, says she’s sympathetic to Congress’s desire to insulate itself from the lobbying onslaught. But she worries that the board is limited to looking only at payments to health providers, which she says “could fundamentally alter the incentives involved in physicians and providers participating in Medicare.”
In other words, it could end up driving Medicare payments so low that providers will simply leave the program, or else go bankrupt if they can’t.
Vladeck, meanwhile, who headed Medicare under President Clinton, has a different problem with the board. He worries that eventually the lobbyists who are now so influential with members of Congress will become equally influential with the unelected members of the board.
“In the short term, it might theoretically work,” he said. But the history with other independent regulatory agencies, like the Interstate Commerce Commission and the Civil Aeronautics Board is that over time “the regulated industries tend to capture them; and they tend to do more to protect the regulated industries than they do to protect consumers.”
The reality is that nobody knows for sure what the IPAB will do, which is why their decisions should at very least be subject to an up or down vote by Congress. An unelected board should not be able to make major decisions regarding a program as important as Medicare without the approval of our elected representatives.