Congress takes a stab at IPAB

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Congressional Republicans -- and even a few Democrats -- are pressing the attack on the Independent Payment Advisory Board for Medicare, a part of the Affordable Care Act opposed by both PhRMA and the AMA.

Yesterday, the House Energy and Commerce Health Subcommittee voted 17 to 5 for repeal of IPAB, the primary cost-cutting mechanism of the Affordable Care Act. The panel's 15 Republicans were joined by two Democrats representing pharmacentric districts – New Jersey's Frank Pallone Jr., who is the ranking Dem on the subcommittee, and New York's Edolphus Towns – in voting to forward the Medicare Decisions Accountability Act of 2011 to the full House. A similar bill, authored by Sen. John Cornyn (R-TX), is bottled up in the Senate.

In a post to The Hill's Congress Blog, the author of the House bill, Tennessee Republican Phil Roe, called IPAB “unaccountable and unworkable,” a “dangerous rationing board” consisting of “fifteen unelected bureaucrats who will decide what constitutes ‘necessary care,' and who will create a ‘one size fits all' solution when it comes to medical care.” Among his bill's 226 co-sponsors are 17 Democrats, and some Senate Democrats facing tough reelection battles might be wobbly on the issue.

Starting in 2015, IPAB, whose members are nominated by the president and approved by the Senate, will have the power to issue binding recommendations for cutting Medicare spending that will take effect unless Congress approves alternate cuts (for a handy IPAB Cliffs Notes, see this Kaiser Health News cheat sheet). The idea is to take Medicare's purse-strings out of the hands of Congress – and the medical industry lobbies that love them. Pharmas and physicians worry that will mean sweeping cuts in Medicare payments, despite language forbidding “any recommendation to ration health care, raise revenues or Medicare beneficiary premiums … increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and co-payments), or otherwise restrict benefits or modify eligibility criteria.”

“We continue to have significant concerns about the overly broad powers of the unelected Independent Payment Advisory Board,” said PhRMA SVP Matt Bennett in a statement issued yesterday. “The board could enact sweeping Medicare changes without Congress' oversight, and their implementation would not be subject to judicial or administrative review. We believe IPAB will result in access problems for Medicare beneficiaries. Therefore, IPAB in its current form must be repealed.”

The AMA said in a letter to committee members that “IPAB is another arbitrary system that could make the same dangerous type of overall cuts” as the periodic shortfalls in funding hitting Medicare and TRICARE patients while Congress wrestles over a fix for the physician payment formula.

“Congress should not make the same mistake again,” said AMA president Peter Carmel in a statement. “Instead of relying on another formula that imposes across-the-board cuts that we know do not work, members of Congress should be taking steps to strengthen Medicare for patients, physicians and taxpayers.”

To a degree, of course, it's all election-year political theater, another showy slap-fight letting members of Congress signal to constituents and lobbies where they stand on the issue. But it also sets the tone for the post-election battle over an issue that's important, said Coalition for Healthcare Communication chief John Kamp, because “It's a precursor to a not-so-nice British-style NICE system. It's about government using its power to reduce the cost of drugs.”
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