The House Budget and Energy and Commerce Health Subcommittee held hearings this week on the Independent Payment Advisory Board (IPAB). IPAB is an unelected and unaccountable board created by the Patient Protection and Affordable Care Act (PPACA) empowered to make recommendations to cut spending in Medicare if its spending growth reaches certain measures. The bulk of any recommended spending reductions will almost certainly come in the form of payment cuts to Medicare providers.
While the legislation in the House to repeal IPAB (H.R. 452) is sponsored by Republicans, it has been gaining bipartisan support. While testifying before the Energy and Commerce Health Subcommittee, Senator Cornyn (R-TX), the lead Senate sponsor of the Senate IPAB repeal legislation, expressed that the IPAB was a bad idea for several reasons: the only tool available to the Board to control Medicare spending growth is provider cuts, the Board has no accountability to Congress or the electorate, and cost shifting to the private sector would be the result. Representative Allyson Schwartz, a leading House Democrat, testified before the committee in opposition to IPAB while stating her strong support for PPACA overall.
Department of Health and Human Services Secretary Kathleen Sebelius defended IPAB in testimony before both committees. The Secretary repeatedly reiterated that IPAB recommendations only go into effect if Congress “does not do its job.” This statement implies that either Congress through the SGR must cut physician payments or IPAB will do it. Either way, physicians will get cut under the current law.
Other Hearing Highlights:
• Secretary Sebelius confirmed that the President is also consulting with individuals about potentially serving on IPAB.
• Secretary Sebelius stated, “I would say that the current fee-for-service system, yes, is unsustainable.”
• Questions were raised concerning constitutionality of IPAB.
• The House Budget Committee hearing focused heavily on comparing the Republican plan for Medicare to IPAB and PPACA.
ASA is extremely troubled by the prospect of sweeping cuts to already unreasonably low Medicare payments for anesthesia services. Cuts by IPAB will have a disproportionate impact on anesthesia services because of the already low payment rates. For those reasons, ASA continues to support repeal of IPAB.
Click here to see video or listen to audio of the July 12 IPAB hearing.
Click here to read the testimony submitted as part of the Energy and Commerce Subcommittee IPAB hearing.