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June 24, 2011 01:00 AM

Going public on IPAB

Rich Daly
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    The battle over the Independent Payment Advisory Board heated up this week with a rare public defense of the controversial cost-control board by the Obama administration.

    HHS Secretary Kathleen Sebelius, in an op-ed for Politico, defended the 15-member board created by the Patient Protection and Affordable Care Act as a “backstop to ensure that rising costs don't accelerate out of control, threatening Medicare's stability.”

    She also noted that President Barack Obama's deficit reduction framework, offered in the spring, would "strengthen" the cost-cutting authority of the board.

    Sebelius' defense of the board is uncommon for the White House but joins an ongoing rear guard of IPAB waged by liberal stalwarts in Congress.

    For example, at a Thursday hearing of the Senate Finance Committee on the rapid rise in federal healthcare spending, Sen. John Rockefeller (D-W.Va.) defended the board not only from Republicans but also from the hearing's Democrat-selected expert witness: Bruce Vladeck, board chairman of the Medicare Rights Center and former administrator of the Health Care Financing Administration, predecessor to the CMS. Vladeck told the committee that IPAB was not the best way to control costs.

    Rockefeller said he overcame the strong objections to IPAB expressed by "30 major hospital directors" in a recent private meeting by raising the possibility that it would include respected policy experts, such as Gail Wilensky, administrator of HCFA during the George H.W. Bush administration, or Stuart Altman, a renowned healthcare economist at Brandeis University.

    “Oh, that'd be fine,” Rockefeller said about the participants' reaction to his suggestion. “In other words, the prejudice is to see any changes in patterns and habits as leading us astray and would lead to micromanagement.”

    The president has yet to appoint any members to the board.

    House Democrats also trumpeted a defense of IPAB this week at a hearing featuring the two public trustees of Medicare.

    “IPAB will help stiffen the spine of Congress,” Rep. Earl Blumenauer (D-Ore.) said at a House Ways and Means Health Subcommittee hearing on June 22.

    He also warned that "we're already seeing people trying to walk back IPAB."

    One of those people is former House Democratic leader Speaker Dick Gephardt, who called for the elimination of IPAB in an op-ed this week on the Huffington Post.

    Gephardt argued that "while technically forbidden from rationing care, the board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them."

    Similar objections have come from Republicans, who have introduced legislation in the House and Senate—backed by many healthcare providers—to repeal IPAB. Cosponsors of IPAB repeal include a handful of Democrats, including some supporters of the law that created IPAB.

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