A bipartisan coalition of hundreds of healthcare organizations is urging the new Congress to immediately repeal an advisory board that has not yet been filled but would be charged with finding cuts to Medicare.
The Independent Payment Advisory Board was created by the Affordable Care Act. During debate of the ACA, some opponents labeled the board a “death panel” that would make decision about end-of-life treatment. It is actually meant to make cuts to Medicare in the case that spending growth exceeds projections.
That hasn't happened since the ACA was enacted. But the most recent report by the Medicare board of trustees states that the condition could be met in 2017, meaning action would have to be taken in the next year.
The 15-member board has never been appointed. The law stipulates that if the board is not appointed, the HHS secretary would then be charged with making the cuts. The cuts could then only be overridden by a supermajority of Congress.
Former U.S. Sen. Kay Hagan of North Carolina who now works as a lobbyist said she is trying to get the votes for repeal in the Senate, and believes many lawmakers could be swayed by the argument that the board—or cuts by the HHS secretary—would undermine congressional authority.
Congress can solve the problem by repealing the IPAB quickly and without question. Otherwise, constituents everywhere could be affected.
“There's no way to blame someone else for this,” she said.
Mary Grealy, president of the Healthcare Leadership Council, said there has been a loose coalition against IPAB since the enactment of the ACA. More than 600 organizations, including the American Medical Association and the U.S. Chamber of Commerce have signed on to a letter asking Congress to repeal the board.
“It's not representative government to have that kind of power reside in an unelected board,” she said.
They have a new urgency with the possibility that spending could trigger the requirement of quick cuts in the next year, Grealy said.
The IPAB was challenged in court by the conservative Goldwater Institute of Phoenix. The U.S. Supreme Court refused to hear the case in early 2015, so the lower court ruling that the case was “unripe” because the board doesn't yet exist still stands.
Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness said whether the cuts are decided by a board or by the HHS secretary, they would have to show quick results and would not be smart or efficient changes.
Important provisions could be done away with, such as a Medicare Part D provision that protects certain classes of drugs like those that treat HIV, Sperling said.
“IPAB could remove it with the flick of a pen,” he said. “And there's nothing we could do about it.”
Grealy said the vows of the new Republican majority to repeal the ACA would not be enough to ensure no harm from IPAB. If the repeal is done with the budget maneuver of reconciliation, IPAB would likely not be included because it has not proven eligible for a change in reconciliation.