WASHINGTON — Following the introduction last week of House and Senate bills that would repeal the medical device tax instituted under the Patient Protection and Affordable Care Act, lawmakers in the House introduced legislation to repeal a provision in the health reform law that created an Independent Payment Advisory Board for Medicare.
The proposed Medicare Decisions Accountability Act (H.R. 452) was introduced Jan. 26 by Rep. Phil Roe, R-Tenn., a physician, and cosponsored by 23 other Republicans.
To begin operation in 2014, the IPAB will be a 15-member independent panel — with members appointed by the president — that could set Medicare reimbursement that would become law unless Congress intervenes.
Industry lobbyist Cara Bachenheimer, senior vice president of government relations for Invacare, explained that the board is charged with enforcing an upper limit on annual Medicare spending growth. "Under the health reform law, Medicare spending is now officially capped," she said.
"Beginning in 2015, Medicare spending is now supposed to be limited, on a per capita basis, to a fixed growth rate, initially set at a mix of general inflation in the economy and inflation in the health sector. Starting in 2018, the upper limit is set permanently at per capita gross domestic product growth plus one percentage point."
The IPAB, then, will be responsible for making recommendations to Congress that would cut payment rates to keep Medicare spending within the prescribed limits. At that point, Bachenheimer said, "If Congress does not act — either vote for or against them — then the Department of Health and Human Services is required to implement IPAB's recommendations."
Proponents of the independent Medicare board believe it will effectively curb spending growth in the massive program. The Congressional Budget Office has estimated the IPAB would save $15.5 billion between 2015 and 2019, the years in which its recommendations will be implemented.
But critics say creation of the board takes accountability for the operation of Medicare from lawmakers and gives it to unelected officials. Roe believes the move could curtail access and care for beneficiaries if physician payments are cut.
"Health care decisions should be made between a physician and the family. You don't need an administration-approved bureaucrat doing it," Roe told reporters at a Jan. 26 press conference.
"Congress' traditional role of controlling payment rates will be eliminated by this IPAB, if indeed Congress chooses to not act on the IPAB recommendations," said Bachenheimer, who last year called the board's creation the "scariest" provision in the health reform law.
Does she still feel that way?
"Most definitely," Bachenheimer said Friday. "It gives this commission essentially unfettered authority to reduce payments to Medicare providers across the board."
Read more of Roe's thoughts on the independent board in his July 2010 op-ed piece in The Washington Times.
