Political posturing related to the Independent Payment Advisory Board aside (Aug. 26 editorial, “The IPAB punching bag,” p. 20), one portion of the IPAB statute that requires examination is a provision that precludes administrative or judicial review of implementation of IPAB's recommendations. In effect, the HHS secretary has been given unfettered discretion to implement major provisions of healthcare reform.
Statutory “preclusion provisions” are pervasive throughout the Patient Protection and Affordable Care Act, in effect gutting government accountability as it applies to many components of the law. Examples? There are plenty: hospital value-based purchasing; the hospital excess-readmissions penalties; new Medicare disproportionate-share payment methodology. The list goes on. These provisions may preclude review/appeal of the government's development and implementation of applicable payment/quality provisions (including application of budget neutrality requirements), thereby eliminating constitutional checks and balances, while also violating due process rights of providers and beneficiaries.
Review of centralized governmental power has been woven into the fabric of our country since it was created. With so much attention given to the ACA, and even IPAB, this issue raises two critical questions: Why do these provisions exist, and why haven't we heard complaints about them?
Theodore Giovanis
T. Giovanis & Co.Highland, Md.
