The concept behind IPAB is relatively simple. Beginning in 2015, if per capita spending on Medicare beneficiaries grows faster than gross domestic product plus 1%, the panel must offer cost-control measures to bring down the growth rate. Congress can either substitute its own cuts or accept the IPAB recommendations, which automatically go into effect if Congress does its usual—that is, nothing.
From the bill's outset, cynical observers dismissed IPAB's ability to shape Medicare's cost curve. They pointed to the controls slapped on physician payments in the late 1990s, which Congress overrides every year with the so-called “doc fix.”
Still, IPAB bashing remains a popular sport for politicians and interest groups, including major healthcare providers. Earlier this year, the American Medical Association endorsed bipartisan House legislation that would repeal IPAB, citing its “power to make indiscriminate cuts.”
The American Hospital Association chimed in with a February endorsement of a Senate IPAB repeal bill “because its existence permanently removes Congress from the process of making decisions regarding Medicare payment.” This blast came despite reform architects having included an exemption for hospitals until 2020, a carve-out specifically designed to ensure the AHA's endorsement of the ACA.
More recently, IPAB has picked up some liberal enemies. Former Vermont Gov. Howard Dean, now a senior consultant to a major lobbying firm, blasted the panel as “essentially a healthcare rationing body” that would set rates so low for physicians and hospitals that “no doctor or hospital will perform them.” Responding at the end of July, former Office of Management and Budget Director Peter Orszag attacked Dean for fundamentally misrepresenting the board's authority.
“The legislation specifically states that the board is not allowed to make any recommendations that would ration care,” Orszag said. IPAB's recommendations, should they become necessary, will more rapidly move the Medicare payment system away from fee-for-service toward the accountable care and bundled-payment models now being tested with some success across the country.