Rule change lets House ignore Medicare IPAB

New parliamentary rules for the current Congress would not require the House to consider recommendations made by the cost-control board.

By Charles Fiegl amednews staff — Posted Jan. 14, 2013

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Any recommendation sent to Congress by the Medicare Independent Payment Advisory Board likely will never be taken up by the Republican-controlled House.

The House adopted rules for the 113th Congress that included a provision addressing the IPAB’s authority to make recommendations on Medicare payment policy. The House rules are an attempt to nullify provisions in the Affordable Care Act “that limit the ability of the House to determine the method of consideration for a recommendation from” IPAB.

“The rules package will better enable us as an institution to perform our constitutional duties and obligations with integrity and transparency, while streamlining our operations,” House Rules Committee Chair Pete Sessions (R, Texas) said in a statement.

House Republicans, who have controlled the chamber since 2011 and will do so at least through 2014, have voted numerous times to repeal the 2010 health system reform law or eliminate certain sections. The IPAB was authorized as a cost-control provision in the law that remains unpopular with many in Washington.

The 15-member board will recommend spending reductions to Medicare when costs exceed growth targets. The law states that Congress must fast-track legislation implementing such reductions, and the changes would take effect automatically unless lawmakers substitute comparable spending reductions or the IPAB plan is overruled by a large majority in the Senate. The Congressional Budget Office has stated that current projections show that the growth target would not be exceeded for at least 10 years.

No one has been appointed to the IPAB, positions that require Senate confirmation. The process for the board drafting recommendations is scheduled to begin as early as April 30, when Medicare’s chief actuary first would determine if spending exceeds growth targets. The IPAB is directed to produce additional Medicare spending reports for Congress even in years when the targets are not exceeded.

Republicans and some Democrats oppose the IPAB and support its repeal. But President Obama and key Senate Democrats support IPAB and have proposed strengthening the board.

Rep. Phil Roe, MD (R, Tenn.), has urged his colleagues to stop the board before it takes any action. In December 2012, he called for an IPAB repeal to be part of negotiations to extend expiring tax cuts and settle other federal budget issues before the end of the year.

“The IPAB — an unelected, unaccountable bureaucracy created by the ACA — has sweeping powers to reduce the growth of Medicare spending,” Dr. Roe stated in a Dec. 17, 2012, letter to House Speaker John Boehner (R, Ohio). “Its proposals will be considered using ‘fast track’ procedures and — absent a three-fifths vote of the Senate — Congress can only modify the type of cuts proposed, not the amount. Should Congress fail to act on the board’s recommendations, they automatically go into effect.”

Organized medicine groups, including the American Medical Association, also have opposed IPAB because of its potential to cut Medicare physician pay rates without what they consider necessary checks and balances.

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