House closer to repeal of Medicare pay board

House Republicans made progress in March in their push to eliminate a 15-person board that would be charged with curbing what the government spends on Medicare.

The House Energy and Commerce Committee on March 6 approved a bill that would repeal the Medicare Independent Payment Advisory Board, a cost-containment measure created under the health system reform law that has drawn significant criticism from physician organizations, including the American Medical Association. The House Ways and Means health subcommittee also approved the bill on March 8.

At this article's deadline, the full House was on track to take up the legislation at the end of March. That's around the time the U.S. Supreme Court is scheduled to hear oral arguments on challenges to the constitutionality of the health reform law. House leaders expect the IPAB repeal bill to pass the House easily.

If the board is left in place, IPAB appointees beginning in 2014 would recommend spending cuts to Medicare anytime projected costs exceed certain targets. Unless overridden by a large majority in Congress, any cost-control recommendations would take effect the following year. Board's supporters say it would contain Medicare costs and keep the program solvent.

But those who oppose IPAB say it could lead to deep pay cuts for physicians and others, make it more difficult for patients to find doctors willing to accept new Medicare patients, and put medical decision-making in the wrong hands.

IPAB "is merely another example of valuing centralized decision-making by government-appointed experts over judgments that should be made between a doctor and patient," Rep. Joseph Pitts (R, Pa.) said during the bill's markup in the House Energy and Commerce health subcommittee.

The legislation's sponsor, Rep. Phil Roe, MD (R, Tenn.), said IPAB would create even further access problems for new Medicare patients trying to find physicians, exacerbating access issues brought on by the Medicare sustainable growth rate formula that calls for deep physician pay cuts that must be blocked by Congress. He said IPAB would be "SGR on steroids."

"If we fix SGR and this is allowed to stay, this trumps it," Dr. Roe said. He acknowledged that Medicare cost growth is a problem, but said IPAB is not the answer.

Dr. Roe's bill had about 20 Democrats as repeal bill co-sponsors by mid-March. Rep. Frank Pallone Jr. (D, N.J.), the top Democrat on the House Energy and Commerce health subcommittee, is among those in his party who supports IPAB repeal. However, he noted that the reasons for his position "are not the same as my Republican colleagues" who want to "repeal the [health reform law] piece by piece." He said his opposition focuses on the "belief that Congress must stop ceding legislative power to the executive branch."

Democrats who opposed the bill said IPAB is the right way to control Medicare costs. During the Commerce markup, top Democrat Henry Waxman (D, Calif.) said the bill might pass the House, but there were not enough votes in the Senate for IPAB repeal.

AMA, White House weigh in

The American Medical Association is among several physician and other health care organizations that have lobbied Congress to repeal the Medicare pay board.

"The IPAB would have far too little accountability and the ability to make across-the-board Medicare cuts," AMA President Peter W. Carmel, MD, said after the House Energy and Commerce Committee passed the bill. "This is not what we need at a time when Congress is already struggling to eliminate a failed formula that threatens access to care for seniors and military families."

In a Feb. 27 letter to lawmakers, the AMA said it appreciates the need to reduce federal budget deficits and control Medicare spending growth. "However, we believe that this can best be achieved by Congress working in a bipartisan manner to reform the delivery system and improve quality, access and efficiency."

The American College of Cardiology also wants to see Congress repeal the panel. "IPAB was a good idea in theory, but the structure does not yield to the goal of the program," Jack Lewin, MD, the group's CEO, said after the House votes.

But the Obama administration championed the panel on its White House blog. It noted that program experts, including former Medicare chief Mark McClellan, MD, PhD, have backed President Obama's call to strengthen the board and its mission.

The left-leaning Center for American Progress, a Washington-based research and educational institute, released a March study saying that repealing IPAB would increase federal deficits and the national debt, putting Medicare at risk. The analysis said IPAB would not ration care or cut benefits, but would save money by prompting changes in the way health care is paid for and delivered.