Both physicians and hospitals oppose IPAB, while lawmakers—including some Democrats—have expressed concern that the panel could usurp control of Congress, and the House of Representatives has voted to repeal it. Meanwhile, the Obama administration has said IPAB is just a backstop measure. HHS Secretary Kathleen Sebelius testified in 2011 that Congress is “in the driver's seat from day one” and pointed out that the panel is prohibited from making recommendations that would ration care, raise beneficiary premiums, increase cost-sharing, reduce benefits or change Medicare eligibility.
But all of the noise surrounding IPAB has since subsided, and news that Congress gutted the program raises questions about the panel's relevance.
“It's sort of an academic discussion,” said Dr. Robert Berenson, a senior fellow at the Urban Institute, a left-of-center think tank. Berenson said IPAB was always intended as a “safety valve” if per-capita cost growth in Medicare surpassed targets, and there has been no need to pull the trigger.
Total Medicare spending per enrollee grew just 0.7% in 2012, even slower than the 2.5% growth rate in 2011, economists in the CMS Office of the Actuary reported this month.
“And yet it's still politically like gunpowder,” Berenson said. “You have a bunch of groups that continually attack it. So I assume the administration doesn't want to have to defend IPAB when it doesn't serve any practical purpose at this point,” he continued. “More importantly, the appointees have to go through hearings to be approved and they didn't even put Don Berwick up,” he said, referring to the Harvard-trained physician who President Barack Obama appointed as CMS administrator during a congressional recess. Berwick departed from his post in late 2011 and never went through the Senate confirmation process.
Stu Guterman, vice president of Medicare and cost control at the Commonwealth Fund, echoed Berenson's comment that there hasn't been a need for IPAB because the growth in spending per person in Medicare has been very low. Earlier this month, economists in the CMS Office of the Actuary reported (PDF) that Medicare spending per enrollee rose by 0.6% in 2012, slower than the 2.5% growth rate in 2011.
In addition to the lack of a pressing need for IPAB, there hasn't been talk of potential appointees.
“I haven't heard anything about nominations being offered or even rumors of people being talked to on the panel,” Guterman said.
If IPAB members are ever appointed and confirmed, Guterman said it will be important that the panel look at policies aimed at slowing not just Medicare cost growth, but overall cost growth in healthcare.
“People have described it as MedPAC on steroids,” Guterman said. “I would kind of describe it as MedPAC on vitamins. MedPAC is a terrific organization, but it was developed to advise Congress and HHS on Medicare policy,” he added. “The IPAB would have its own focus. IPAB would hopefully be able to take a step back and take a broader view.”
