Targeting IPAB

Ever since health care reform passed in March, it's had a huge target on its back by those who want to repeal it. Unfortunately, the bullseye for some is on one of the Medicare cost-control provisions in the legislation that is essential to bending the health care cost curve down.

The Independent Payment Advisory Board (IPAB) is charged with finding ways to reduce Medicare spending when it exceeds certain limits. Its recommendations are subject to an up-or-down vote by Congress. If they are not approved, then Congress must find equivalent savings elsewhere. After six months, if Congress fails to act either with IPAB's recommendations or their own, the Department of Health and Human Services can implement the original IPAB policies.

Five senators--John Cornyn, Jon Kyl, Orrin Hatch, Pat Roberts, and Tom Coburn--are leading the charge to repeal IPAB. They object to essentially taking away the decision-making power from Congress (although that isn't really the case) and putting it into the hands of unelected officials. 

Elected officials have had plenty of opportunities to take significant steps to control the growth of Medicare. Currently, a Medicare commission already exists--the Medicare Payment Advisory Commission--but its recommendations are non-binding and have been consistently ignored by Congress. And as Ezra Klein has said, when Congress is unwilling to take action on something, "the result isn't inaction, but non-congressional forms of action." That is what we are seeing here.

We have argued that cost-control provisions like IPAB need to be strengthened, not repealed, especially considering how important controlling cost growth is to our long-term fiscal health. IPAB is a good step towards forcing Congress to act, when inaction has been the default option. 

We've suggested ways to strengthen IPAB to better control Medicare growth, mainly by "spreading the pain." The current scope of the Board mainly only allows it to deal with provider payments, but this approach has raised concerns about reduced access. If the scope of IPAB is widened to include changes to beneficiary costs and eligibility rules, it would be a more effective cost control method than one that simply relies on reducing provider payments.

Improving IPAB should certainly be looked at, but repeal should be out of the question unless opponents propose an alternative way to control costs.