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The '''Independent Payment Advisory Board''', or '''IPAB''', is a [[Federal government of the United States|United States Government]] [[Government agency|agency]] created in 2010 by sections 3403 and 10320 of the [[Patient Protection and Affordable Care Act]]. Funding for the Board begins in 2012,<ref>{{USStat|111|506}}; to be codified at {{USC|42|1899A(m)(1)(A)}}</ref> and the law requires the Board to issue its first proposals in 2014.<ref>{{USStat|111|492}}; to be codified at {{USC|42|1899A(c)(3)(A)(1).}}</ref>
The '''Independent Payment Advisory Board''', or '''IPAB''', is a [[Federal government of the United States|United States Government]] [[Government agency|agency]] created in 2010 by sections 3403 and 10320 of the [[Patient Protection and Affordable Care Act]]. Funding for the Board begins in 2012,<ref>{{USStat|111|506}}; to be codified at {{USC|42|1899A(m)(1)(A)}}</ref> and the law requires the Board to issue its first proposals in 2014.<ref>{{USStat|111|492}}; to be codified at {{USC|42|1899A(c)(3)(A)(1).}}</ref>
Its purpose is to reduce the per capita rate of growth in [[Medicare (United States)|Medicare]] spending.<ref name="usc">{{USStat|111|489}}; to be codified at {{USC|42|1899A(b).}}</ref> The law requires the Chief Actuary of the [[Centers for Medicare and Medicaid Services]] to determine in particular years the projected [[per capita]] growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending. The [[United States Secretary of Health and Human Services|Secretary of Health and Human Services]] must then implement the proposal unless [[United States Congress|Congress]] enacts legislation pursuant to a fast-track procedure that the law sets forth.<ref name="usc"/> The IPAB is explicitly prohibited from rationing, With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."<ref>{{USStat|111|490}}; to be codified at {{USC|42|1899A(c)(2)(A)(ii).}}</ref>
Its purpose is to reduce the per capita rate of growth in [[Medicare (United States)|Medicare]] spending.<ref name="usc">{{USStat|111|489}}; to be codified at {{USC|42|1899A(b).}}</ref> The law requires the Chief Actuary of the [[Centers for Medicare and Medicaid Services]] to determine in particular years the projected [[per capita]] growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending. The [[United States Secretary of Health and Human Services|Secretary of Health and Human Services]] must then implement the proposal unless [[United States Congress|Congress]] enacts legislation pursuant to a fast-track procedure that the law sets forth.<ref name="usc"/> The IPAB is explicitly prohibited from rationing.


==Objectives==
==Objectives==
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From June 17 to September 14, 2009, three Democratic and three Republican [[United States Senate Committee on Finance|Senate Finance Committee]] members met for a series of 31 meetings to discuss the development of a health care reform bill, including an independent board that the senators informally described as “MedPAC on steroids.” During this period, Senators [[Max Baucus]] (D-Montana), [[Chuck Grassley]] (R-Iowa), [[Kent Conrad]] (D-North Dakota), [[Olympia Snowe]] (R-Maine), [[Jeff Bingaman]] (D-New Mexico), and [[Mike Enzi]] (R-Wyoming), met for more than 60 hours, and their discussions established the principles upon which healthcare reform legislation was later passed.<ref>{{cite web|title=Health Care Reform from Conception to Final Passage|accessdate=November 23, 2010|url=http://finance.senate.gov/issue/?id=32be19bd-491e-4192-812f-f65215c1ba65}}</ref> The Senate Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.<ref>See generally Stockdale (2010).</ref>
From June 17 to September 14, 2009, three Democratic and three Republican [[United States Senate Committee on Finance|Senate Finance Committee]] members met for a series of 31 meetings to discuss the development of a health care reform bill, including an independent board that the senators informally described as “MedPAC on steroids.” During this period, Senators [[Max Baucus]] (D-Montana), [[Chuck Grassley]] (R-Iowa), [[Kent Conrad]] (D-North Dakota), [[Olympia Snowe]] (R-Maine), [[Jeff Bingaman]] (D-New Mexico), and [[Mike Enzi]] (R-Wyoming), met for more than 60 hours, and their discussions established the principles upon which healthcare reform legislation was later passed.<ref>{{cite web|title=Health Care Reform from Conception to Final Passage|accessdate=November 23, 2010|url=http://finance.senate.gov/issue/?id=32be19bd-491e-4192-812f-f65215c1ba65}}</ref> The Senate Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.<ref>See generally Stockdale (2010).</ref>


⚫
The [[Congressional Budget Office]] (CBO) estimated that IPAB will achieve Medicare spending reductions of $15.5 billion over its first five years of operation. This amounts to 0.5% of projected Medicare spending for that period.<ref name="healthblog">[http://www.thehealthcareblog.com/the_health_care_blog/2010/07/the-effectiveness-of-ipab-.html The Effectiveness of IPAB], by Roger Collier, The Health Care Blog, 6 July 2010</ref>
===Claims of rationing===
⚫
Some critics of IPAB argue that the board will lead to rationing or otherwise reduce the availability of medical services for Medicare beneficiaries. IPAB supporters strongly deny this.<ref>Richard Reeb. [http://www.desertdispatch.com/articles/government-8760-health-rationing.html “Health care rationing is bound to come.”] ''Desert Dispatch''. (June 29, 2010).</ref>


===Prohibits rationing, increased cost sharing, restricting benefits or eligibility criteria===
⚫
Some IPAB supporters claim that lower per capita health spending in foreign countries that also enjoy superior average levels of health points to the possibility of reducing healthcare spending without harming patients. "In most [medical] resources we have a surplus," said Dr. David Himmelstein of [[Physicians for a National Health Program]]. "People get large amounts of care that don't do them any good and might cause them harm [while] others don't get the necessary amount."<ref name="Motherjones">James Ridgeway. [http://motherjones.com/politics/2010/07/health-care-rationing-death-panels “Meet the Real Death Panels.”] ''Mother Jones''. (July/August 2010).</ref>


With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."<ref>{{USStat|111|490}}; to be codified at {{USC|42|1899A(c)(2)(A)(ii).}}</ref>
Advocates of healthcare reform sometimes emphasize what they view as excessive care for the terminally ill. During an interview when asked about end-of-life care President Obama said, "I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here." In response to a query about possible solutions he answered, "And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance."<ref name="Nymag">David Leonhardt. [http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?pagewanted=1 “After the Great Recession--An Interview With President Obama.”] ''The New York Times'' Magazine. (April 28, 2009).</ref>


⚫
Some critics of IPAB do, however, argue that the board will lead to rationing or otherwise reduce the availability of medical services for Medicare beneficiaries. IPAB supporters strongly deny this.<ref>Richard Reeb. [http://www.desertdispatch.com/articles/government-8760-health-rationing.html “Health care rationing is bound to come.”] ''Desert Dispatch''. (June 29, 2010).</ref>
Efforts by the British [[National Health Service]] (NHS) to establish a system where approval of medical treatments is tied to their cost per quality adjusted life year (QALY) have been mentioned approvingly in support of IPAB.{{citation needed|date=December 2010}} Under this QALYs equivalent to good health have a value of "one". An extra two years of life in a state of health rated half as good would also have a value of "one". The NHS National Institute for Health and Clinical Excellence frequently rejects treatments costing more than 30,000 pounds per QALY.<ref name="Motherjones"/>

⚫
Some IPAB supporters claim that lower per capita health spending in foreign countries that also enjoy superior average levels of health points to the possibility of reducing healthcare spending without harming patients. "In most [medical] resources we have a surplus," said Dr. David Himmelstein of [[Physicians for a National Health Program]]. "People get large amounts of care that don't do them any good and might cause them harm [while] others don't get the necessary amount."<ref name="Motherjones">James Ridgeway. [http://motherjones.com/politics/2010/07/health-care-rationing-death-panels “Meet the Real Death Panels.”] ''Mother Jones''. (July/August 2010).</ref>


The law creating IPAB prohibits rationing, stating with regard to IPAB's recommendations: "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."<ref>{{USStat|111|490}}; to be codified at {{USC|42|1899A(c)(2)(A)(ii).}}</ref>
The law creating IPAB prohibits rationing, stating with regard to IPAB's recommendations: "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."<ref>{{USStat|111|490}}; to be codified at {{USC|42|1899A(c)(2)(A)(ii).}}</ref>
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===Political use of death panel term===
===Political use of death panel term===


In December 2010, Sarah Palin wrote in the ''Wall Street Journal'' that the [[National Commission on Fiscal Responsibility and Reform]] "implicitly endorses the use of "[[death panel]]"-like rationing by way of the new Independent Payments [''[[sic]]''] Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare."<ref>Palin, Sarah, [http://online.wsj.com/article/SB10001424052748703766704576009322838245628.html?mod=rss_opinion_main Why I Support the Ryan Roadmap], ''Wall Street Journal'', December 10, 2010.</ref> [[FactCheck.org]] replied to Palin's op-ed by saying her description was wrong on three counts:
In December 2010, Sarah Palin wrote in the ''Wall Street Journal'' that the [[National Commission on Fiscal Responsibility and Reform]] "implicitly endorses the use of "[[death panel]]"-like rationing by way of the new Independent Payments [''[[sic]]''] Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare."<ref>Palin, Sarah, [http://online.wsj.com/article/SB10001424052748703766704576009322838245628.html?mod=rss_opinion_main Why I Support the Ryan Roadmap], ''Wall Street Journal'', December 10, 2010.</ref> IPAB was not Palin's original Death Panel nor even her second or third. In June 2009 she said she did not want to live in America in which her elderly parents or her disabled son would have to stand before and please for their lives based on Obama's "death panel's" perception of their worth to society. When nobody could find such a panel in the law, Palin's spokeswomen said she was talking about paid for sessions in medicare for people to receive advice about living wills. This "death panel allegation was fact checked as false. Later still she said that she had been referring to the words of a brother of a Senior Whitehouse offical who is a medical ethicist. Her understanding of those words turned out to be a "misunderstanding". This detail too was fact checked as false. The ethicist is in fact a fierce opponent of euthanasia. Later still she said that she had said she was being hyperbolic in her use of language but she realized that as more people were going to get health care under the Obama legislation, this would of necessity entail rationing. Of her December 2010 explanation tying the term to IPAB, [[FactCheck.org]] said her description was wrong on three counts:
*the board doesn’t have the power to ration health care;
*the board doesn’t have the power to ration health care;
*board members won’t be all "bureaucrats" (since the law requires that it include medical professionals, other health care providers, medical researchers, experts in health care finance and actuarial science, employers representatives, and the elderly; and
*board members won’t be all "bureaucrats" (since the law requires that it include medical professionals, other health care providers, medical researchers, experts in health care finance and actuarial science, employers representatives, and the elderly; and
*board members will not be the "ultimate arbiters," since Congress has the authority to change or block their recommendations, although special legislative procedures make it more difficult than usual for Congress to act.<ref name="distortions">{{cite web |url=http://www.factcheck.org/2010/12/let-the-distortions-begin/ |title=Let the distortions begin; A sneak preview of what to expect as 2012 comes into focus |author=Eugene Kiely, Dangelo Gore and Viveca Novak |date=December 23, 2010 |work=[[FactCheck.org]] |accessdate=January 13, 2011}}</ref>
*board members will not be the "ultimate arbiters," since Congress has the authority to change or block their recommendations, although special legislative procedures make it more difficult than usual for Congress to act.<ref name="distortions">{{cite web |url=http://www.factcheck.org/2010/12/let-the-distortions-begin/ |title=Let the distortions begin; A sneak preview of what to expect as 2012 comes into focus |author=Eugene Kiely, Dangelo Gore and Viveca Novak |date=December 23, 2010 |work=[[FactCheck.org]] |accessdate=January 13, 2011}}</ref>


''The New York Times'' reported in April 2010 that some Obama administration officials feared the IPAB could be "target for attacks of the 'death panel' sort".<ref>{{cite news |title=After Health Care Passage, Obama Pushes to Get It Rolling |author=Jackie Calmes |newspaper=The New York Times |date=April 17, 2010 |url=http://www.nytimes.com/2010/04/18/health/policy/18cost.html |accessdate=}}</ref> An October 2010 [[National Right to Life Committee|National Right to Life]] article wrote the IPAB was "a good candidate for the title of 'death panel'".<ref>{{cite journal |author=Burke J. Balch |year=2010 |month=October |title=Are ObamaCare "Death Panels" Truly a Myth? |journal=National Right to Life News |publisher=[[National Right to Life Committee]] |volume=37 |issue=10 |pages=10, 18 |url=http://www.nrlc.org/news_and_views/Oct10/nv100110part2.html}}</ref> Former OMB Director Orszag responded: "I think it's only in Washington, D.C., that a board created to help address our long-term fiscal imbalance while boosting quality in health care and that is specifically by law prohibited from rationing care could be called a death panel".<ref>{{cite journal |author=[[Jon Meacham]] |date=May 10, 2010<!-- date associated with the volume and issue, not the internet article--> |title=In Search of a Fiscal Cure |journal=[[Newsweek]] |volume=155 |issue=19 |pages= |url=http://www.newsweek.com/2010/04/30/in-search-of-a-fiscal-cure.html }}</ref>
''The New York Times'' reported in April 2010 that some Obama administration officials feared the IPAB could be "target for attacks of the 'death panel' sort".<ref>{{cite news |title=After Health Care Passage, Obama Pushes to Get It Rolling |author=Jackie Calmes |newspaper=The New York Times |date=April 17, 2010 |url=http://www.nytimes.com/2010/04/18/health/policy/18cost.html |accessdate=}}</ref>

===Constitutionality===

Some opponents of IPAB argue that it amounts to unconstitutional "entrenchment." Specifically, Jeff Flake, Trent Franks, and John Shadegg, Members of the [[United States House of Representatives]] argued that allowing IPAB proposals to become law without congressional or presidential approval and the requirement that IPAB cannot be repealed until 2017, and then only under stringent rules, unconstitutionally restrict the freedom of future congresses to pass legislation in violation of the First Amendment, the Separation of Powers, and the Article I powers of Congress.<ref name="Goldwater2">[http://goldwaterinstitute.org/coonsvgeithner Coons v. Geithner], The Goldwater Institute, 12 August 2010</ref><ref name="Maine">David Crocke. [http://www.mainepolicy.org/2011/01/the-case-against-obamacare/ "The Case Against ObamaCare."] The Maine Heritage Policy Center. 10 January 2011.</ref> A motion drafted by the conservative [[Goldwater Institute]] has requested that District Court Judge Murray Snow issue an injunction against provisions of the healthcare reform law that restrict repeal of IPAB.<ref name="Goldwater">The Goldwater Institute. [http://www.goldwaterinstitute.org/article/5497 "Federal Court Rules Federal Heath Care Law Unconstitutional."] 13 December 2010.</ref>

In its brief defending the law, the [[United States Department of Justice]] says: "the challenged provision does no such thing. Rather, it creates a parliamentary procedure whereby Congress may use an expedited process to consider legislation that would discontinue the Independent Payment Advisory Board . . . . Plaintiffs’ claim that the provision somehow blocks repeal is simply incorrect. As with all statutes, plaintiffs remain free to introduce or vote on legislation to repeal the statutory provision that creates the Board."<ref>Department of Justice. ''Coons v. Geithner'', Response to Plaintiffs’ Motion for Preliminary Injunction. Filed December 10, 2010.</ref>

====Separation of Powers====

Speaking on the issue of delegating legislative authority Peter Orszag, former White House Budget director and IPAB supporter stated, "I believe this commission is the largest yielding of sovereignty from the Congress since the creation of the Federal Reserve.”<ref name="klein">[http://voices.washingtonpost.com/ezra-klein/2010/03/can_we_control_costs_without_c.html Can we control costs without Congress?], by Ezra Klein, The Washington Post, 26 March 2010</ref>

===Congressional Budget Office scoring===

⚫
The [[Congressional Budget Office]] (CBO) estimated that IPAB will achieve Medicare spending reductions of $15.5 billion over its first five years of operation. This amounts to 0.5% of projected Medicare spending for that period.<ref name="healthblog">[http://www.thehealthcareblog.com/the_health_care_blog/2010/07/the-effectiveness-of-ipab-.html The Effectiveness of IPAB], by Roger Collier, The Health Care Blog, 6 July 2010</ref>


==Proposed legislative changes==
==Proposed legislative changes==
===Repeal efforts===
===Repeal efforts===
During the health care reform debate of 2009-2010 that ended with the passage of the legislation by the Democratic-dominated Congress, Republicans proposed striking provisions in the bill that would require Medicare cost control. While voting yes on the legislation in April 2010, one liberal congressman, [[Pete Stark]] (D-Calif.), said that the IPAB "sets [Medicare] up for unsustainable cuts" that will endanger the health of patients, and that he would "work tirelessly to mitigate the damage" the panel would cause.<ref name="Hill1">Julian Pecquet. [http://thehill.com/blogs/healthwatch/politics-elections/124859-gop-staffer-look-to-healthcare-debate-for-repeal-clues “GOP staffer: Look to healthcare debate for repeal clues.”] ''The Hill''. (October 19, 2010).</ref>

In August 2010, high-ranking Senate Republicans introduced a bill to repeal provisions for the panel, "saying that 'unelected, unaccountable bureaucrats' should not be given such significant power over Medicare."<ref>{{cite web|url=http://www.californiahealthline.org/road-to-reform/2010/some-fear-ipab-will-be-error-of-commission.aspx#ixzz19KwxzBJ4|date=August 18, 2010|title=Some Fear IPAB Will Be Error of Commission|author=Dan Diamond|work=California Healthline|accessdate=December 27, 2010}}</ref>

Rep. Pete Stark, a Democrat from California who voted in favor of health care reform, said that IPAB is a "dangerous provision" that "sets [Medicare] up for unsustainable cuts" and endangers patients' health. "I intend to work tirelessly to mitigate the damage that will be caused by IPAB," stated Stark. Yet Stark, the ranking Democrat on the health subpanel of Ways and Means Committee, issued a 14-page talking point report in December 2010 to help other Democrats "hone their arguments" against repeal efforts by the Republicans.<ref name="Dems prepare">{{cite news|title=Dems prepare defense of healthcare law in face of repeal threats|url=http://thehill.com/blogs/healthwatch/health-reform-implementation/134441-with-repeal-threat-looming-democrats-set-to-defend-healthcare-law|author=Julian Pecquet|date=December 21, 2010|work=The Hill|accessdate=December 27, 2010}}</ref>


IPAB has been defended as merely a tool to help control costs in an inefficient health care market.<ref>{{cite web|url=http://www.kaiserhealthnews.org/Columns/2010/August/080210Cohn.aspx|date=August 2, 2010|title=Why The Health Reform Repealers Are Wrong|author=Jonathan Cohn|accessdate=January 14, 2010}}</ref>
In August 2010, high-ranking Senate Republicans introduced a bill to repeal provisions for the panel, "saying that 'unelected, unaccountable bureaucrats' should not be given such significant power over Medicare."<ref>{{cite web|url=http://www.californiahealthline.org/road-to-reform/2010/some-fear-ipab-will-be-error-of-commission.aspx#ixzz19KwxzBJ4|date=August 18, 2010|title=Some Fear IPAB Will Be Error of Commission|author=Dan Diamond|work=California Healthline|accessdate=December 27, 2010}}</ref>


===Fiscal Commission report===
===Fiscal Commission report===

Revision as of 22:32, 3 February 2011

The Independent Payment Advisory Board, or IPAB, is a United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act. Funding for the Board begins in 2012,[1] and the law requires the Board to issue its first proposals in 2014.[2] Its purpose is to reduce the per capita rate of growth in Medicare spending.[3] The law requires the Chief Actuary of the Centers for Medicare and Medicaid Services to determine in particular years the projected per capita growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending. The Secretary of Health and Human Services must then implement the proposal unless Congress enacts legislation pursuant to a fast-track procedure that the law sets forth.[3] The IPAB is explicitly prohibited from rationing.

Objectives

IPAB is tasked with developing specific proposals to bring the the net growth in Medicare spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015. The proposals must not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums increase Medicare beneficiary cost sharing (deductibles, coinsurance, or copayments), or otherwise restrict benefits or modify eligibility criteria. [4]The Department of Health and Human Services must implement these proposals unless Congress adopts equally effective alternatives. The board is also required to submit to Congress annual reports on health care costs, access, quality, and utilization. IPAB must submit to Congress recommendations on how to slow the growth in total private health care expenditures.[5]

Every year on September 1, IPAB must submit a draft proposal to the Secretary of Health and Human Services. On January 15 of the next year IPAB must submit a proposal to Congress. If IPAB fails to meet this deadline, the Department of Health and Human Services (DHHS) must create its own proposal . Congress must consider this proposal under special rules. Congress cannot consider any amendment to the proposal that does not achieve similar cost reductions unless both houses of Congress, including a three-fifths super majority in the Senate, vote to waive this requirement. If Congress fails to adopt a substitute provision by August 15, DHHS must implement the proposal as originally submitted to Congress.[5]

Former Office of Management and Budget Director Peter Orszag has called creation of the IPAB “perhaps most important” among the cost-containing steps taken in the Patient Protection and Affordable Care Act.[6] But IPAB has also been listed among targets that Congressional Republicans might deny funds in an effort to thwart the new health care reform law.[7]

Princeton University health care economist Uwe Reinhardt said in November 2010 that he thought the board was the most potent tool to restrain health care inflation but the "problem is that the Republicans, without killing the authorization for this body, could kill it by just not funding it, and they would get some Democrats to go along with this because a lot of Congressmen don't like some outside body to tie its hands. My own feeling is that this commission that would be powerful is not going to survive."[8]

Membership and term of office

IPAB is composed of 15 members appointed by the President, subject to Senate confirmation. The Secretary of HHS, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration serve ex officio as nonvoting members.[9] In making the appointments, the President consults with the Majority Leader of the Senate concerning the appointment of three members; the Speaker of the House of Representatives concerning the appointment of three members, the Minority Leader of the Senate concerning the appointment of three members, and the Minority Leader of the House of Representatives concerning the appointment of three members.[10]

The first members appointed to the board will be divided into three staggered classes in order to ensure that their terms do not expire simultaneously. Five will be appointed for a term of 1 year, five will be appointed for a term of three years, and five will be appointed for a term of six years. All subsequent appointments will be made for six years. A member may not serve more than two full consecutive terms.[11]

Members will be paid at a rate described in Level III of the Executive Schedule that determines pay for senior executive branch officials. As of 2010 this is $165,300 per year.[5]

Legislative history & CBO scoring

IPAB was created in response to criticism of the Medicare Payment Advisory Commission (MedPAC), a body with no regulatory power that advises Congress. Critics claimed that "hundreds of billions of dollars" in spending cuts were proposed by MedPAC but never acted upon by Congress.[12] On June 25, 2009, Senator Jay Rockefeller introduced the Medicare Payment Advisory Commission Reform Act of 2009, which would have changed MedPAC into an executive branch agency.[13] On July 17, 2009, the Obama administration submitted to Congress a similar proposal called the Independent Medicare Advisory Council Act (IMAC), which would have created an independent five-member executive council to make recommendations to the president.

From June 17 to September 14, 2009, three Democratic and three Republican Senate Finance Committee members met for a series of 31 meetings to discuss the development of a health care reform bill, including an independent board that the senators informally described as “MedPAC on steroids.” During this period, Senators Max Baucus (D-Montana), Chuck Grassley (R-Iowa), Kent Conrad (D-North Dakota), Olympia Snowe (R-Maine), Jeff Bingaman (D-New Mexico), and Mike Enzi (R-Wyoming), met for more than 60 hours, and their discussions established the principles upon which healthcare reform legislation was later passed.[14] The Senate Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.[15]

The Congressional Budget Office (CBO) estimated that IPAB will achieve Medicare spending reductions of $15.5 billion over its first five years of operation. This amounts to 0.5% of projected Medicare spending for that period.[16]

Prohibits rationing, increased cost sharing, restricting benefits or eligibility criteria

With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."[17]

Some critics of IPAB do, however, argue that the board will lead to rationing or otherwise reduce the availability of medical services for Medicare beneficiaries. IPAB supporters strongly deny this.[18]

Some IPAB supporters claim that lower per capita health spending in foreign countries that also enjoy superior average levels of health points to the possibility of reducing healthcare spending without harming patients. "In most [medical] resources we have a surplus," said Dr. David Himmelstein of Physicians for a National Health Program. "People get large amounts of care that don't do them any good and might cause them harm [while] others don't get the necessary amount."[19]

The law creating IPAB prohibits rationing, stating with regard to IPAB's recommendations: "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."[20]

Political use of death panel term

In December 2010, Sarah Palin wrote in the Wall Street Journal that the National Commission on Fiscal Responsibility and Reform "implicitly endorses the use of "death panel"-like rationing by way of the new Independent Payments [sic] Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare."[21] IPAB was not Palin's original Death Panel nor even her second or third. In June 2009 she said she did not want to live in America in which her elderly parents or her disabled son would have to stand before and please for their lives based on Obama's "death panel's" perception of their worth to society. When nobody could find such a panel in the law, Palin's spokeswomen said she was talking about paid for sessions in medicare for people to receive advice about living wills. This "death panel allegation was fact checked as false. Later still she said that she had been referring to the words of a brother of a Senior Whitehouse offical who is a medical ethicist. Her understanding of those words turned out to be a "misunderstanding". This detail too was fact checked as false. The ethicist is in fact a fierce opponent of euthanasia. Later still she said that she had said she was being hyperbolic in her use of language but she realized that as more people were going to get health care under the Obama legislation, this would of necessity entail rationing. Of her December 2010 explanation tying the term to IPAB, FactCheck.org said her description was wrong on three counts:

  • the board doesn’t have the power to ration health care;
  • board members won’t be all "bureaucrats" (since the law requires that it include medical professionals, other health care providers, medical researchers, experts in health care finance and actuarial science, employers representatives, and the elderly; and
  • board members will not be the "ultimate arbiters," since Congress has the authority to change or block their recommendations, although special legislative procedures make it more difficult than usual for Congress to act.[22]

The New York Times reported in April 2010 that some Obama administration officials feared the IPAB could be "target for attacks of the 'death panel' sort".[23]

Proposed legislative changes

Repeal efforts

In August 2010, high-ranking Senate Republicans introduced a bill to repeal provisions for the panel, "saying that 'unelected, unaccountable bureaucrats' should not be given such significant power over Medicare."[24]

Fiscal Commission report

In a 11-to-7 vote the commission recommended strengthening IPAB. The vote failed to reach the supermajority of 14 required to refer its proposals to Congress. Specifically, the commission voted to repeal exemptions from IPAB written into current law that exempt certain healthcare providers from its decisions for several years.[25][26][27][28] The commission's report generated strong concern among consumer and industry groups.[29]

Funding

$15 million has been appropriated for IPAB in 2012. Future funding for the agency will be based on this figure but adjusted for inflation.[5]

References

  1. ^ 111 Stat. 506; to be codified at 42 U.S.C. § 1899A(m)(1)(A)
  2. ^ 111 Stat. 492; to be codified at 42 U.S.C. § 1899A(c)(3)(A)(1).
  3. ^ a b 111 Stat. 489; to be codified at 42 U.S.C. § 1899A(b).
  4. ^ consolidated bill Sec. 3403\1899A SSA page 409
  5. ^ a b c d Timothy Stoltzfus Jost. “The Independent Payment Advisory Board.” The New England Journal of Medicine. (May 26, 2010).
  6. ^ Peter Orszag. “To Save Money, Save the Health Care Act.” New York Times (November 4, 2010): A29.
  7. ^ David Hogberg. “GOP Attack Will Start at Repeal of ObamaCare; Cantor: Chip Away, Defund.” Investor's Business Daily (November 4, 2010): A1.
  8. ^ John Greenwald. “Reinhardt: Repeal Health Care, Make GOP Cut Costs.” The Fiscal Times (November 29, 2010).
  9. ^ 111 Stat. 502; to be codified at 42 U.S.C. § 1899A(g)(1)(A).
  10. ^ 111 Stat. 503; to be codified at 42 U.S.C. § 1899A(g)(1)(E).
  11. ^ 111 Stat. 503; to be codified at 42 U.S.C. § 1899A(g)(2).
  12. ^ Mike Lillis. “GOP leaders push to repeal Medicare cost-cutting panel.” The Hill. (July 28, 2010).
  13. ^ S. 1380
  14. ^ "Health Care Reform from Conception to Final Passage". Retrieved November 23, 2010.
  15. ^ See generally Stockdale (2010).
  16. ^ The Effectiveness of IPAB, by Roger Collier, The Health Care Blog, 6 July 2010
  17. ^ 111 Stat. 490; to be codified at 42 U.S.C. § 1899A(c)(2)(A)(ii).
  18. ^ Richard Reeb. “Health care rationing is bound to come.” Desert Dispatch. (June 29, 2010).
  19. ^ James Ridgeway. “Meet the Real Death Panels.” Mother Jones. (July/August 2010).
  20. ^ 111 Stat. 490; to be codified at 42 U.S.C. § 1899A(c)(2)(A)(ii).
  21. ^ Palin, Sarah, Why I Support the Ryan Roadmap, Wall Street Journal, December 10, 2010.
  22. ^ Eugene Kiely, Dangelo Gore and Viveca Novak (December 23, 2010). "Let the distortions begin; A sneak preview of what to expect as 2012 comes into focus". FactCheck.org. Retrieved January 13, 2011.
  23. ^ Jackie Calmes (April 17, 2010). "After Health Care Passage, Obama Pushes to Get It Rolling". The New York Times.
  24. ^ Dan Diamond (August 18, 2010). "Some Fear IPAB Will Be Error of Commission". California Healthline. Retrieved December 27, 2010.
  25. ^ Erik Wasson. “Rep. Ryan says deficit reduction plan would ‘entrench ObamaCare’” The Hill. (December 2, 2010).
  26. ^ The National Commission on Fiscal Responsibility and Reform. The Moment of Truth, at 41. Dec. 2010.
  27. ^ Derek Thompson, "The Plan to Balance the Budget: The Fiscal Commission's Final Report." The Atlantic. (December 1, 2010).
  28. ^ Ezra Klein. “The best and worst of Simpson-Bowles.” The Washington Post. (December 3, 2010).
  29. ^ Mathew DoBias. “Deficit Panel Offers Partial Answer on Health Care.” National Journal. (December 1, 2010).

External links

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