Hearings Over Controversial Healthcare “Cutting” Board
Notes from Jessie Gibbons, TSCL Legislative Analyst
Recently the House Budget Committee and the House Energy and Commerce Committee both held hearings on the controversial Independent Payment Advisory Board (IPAB). The IPAB was created under the healthcare reform law to slow rising Medicare costs. If costs grow too fast, the IPAB would recommend cuts that would go into effect unless Congress comes up with the same amount of savings. Both Committees heard testimony from Health and Human Services (HHS) Secretary Kathleen Sebelius, among many others.
At the hearings, many Committee Members were still getting up to speed on the structural and procedural aspects of the IPAB. The IPAB, which will be made up of 15 “experts” appointed by the President and confirmed by the Senate, will begin issuing recommendations to Congress in 2015 if Medicare spending exceeds the targets established by the Affordable Care Act. Those recommendations will be reviewed on a “fast-track” basis, and, if Congress fails to act quickly, HHS will be forced to implement them.
Support for the IPAB at both hearings was scarce. Some Members, including the Ranking Member of the House Budget Committee, Chris Van Hollen (MD), called the IPAB a necessary “failsafe” measure that will stabilize healthcare costs. He stressed the fact that the experts on the IPAB will make recommendations, but Congress will ultimately have the final say in whether or not they become law.
Supporters also stressed the fact that the IPAB has strict limitations. The Board cannot restrict Medicare benefits, raise taxes, increase beneficiaries’ cost-sharing, modify eligibility criteria, cut payments to hospitals before 2020, or ration care. Instead, the IPAB will report on healthcare costs, access, quality, and utilization each year, and will make innovative cost-saving recommendations as it sees fit.
A majority of those at this week’s hearings, however, were strongly opposed to the IPAB. Multiple Members referred to it as the “denial of care board,” and Ranking Member of the Energy and Commerce Committee Frank Pallone (NJ) called it the fruits of a “growing, imperialistic presidency.” Critics believe that it will undermine Congress’s ability to represent their constituents, and that elected officials — not a Board of Presidential appointees — should be legislating healthcare policy.
Another major concern for those at the hearings was that the IPAB might inadvertently ration care. The law explicitly prohibits this, but many fear that without clarifying the definition of “rationing,” there will likely be many discrepancies in the future. Rep. Phil Gingrey (GA) pointed out that what one calls rationing, another might simply consider reducing costs.
Rep. Phil Roe (TN), who served as a witness at the Energy and Commerce hearing, introduced legislation in January to repeal the IPAB. The bill currently has bipartisan support and more than 160 cosponsors. While some, including President Obama and his Fiscal Commission, have proposed strengthening the authority of the IPAB, most at this week’s hearings expressed their support for legislation that would eliminate it.