Quest to get Congress to repeal the Independent Payment Advisory Board heats up

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A coalition of 700 healthcare groups is on a mission to get Congress to get rid of the Independent Payment Advisory Board before it’s too late.

The Independent Payment Advisory Board (IPAB) has been unpopular almost from the moment it was included in the Affordable Care Act. But now, a coalition of 700 healthcare groups is on a mission to get Congress to get rid of the program before it’s too late.

IPAB was designed as a mechanism that would be triggered if Medicare spending exceeds a particular limit. A 15-member board would then make recommendation for cuts to reduce the spending growth curb. But since no members have been named to IPAB, its authority is automatically transferred to the secretary of Health and Human Services.

Trade groups, such as the American Hospital Association and the American Medical Association, have long opposed the IPAB and submitted letters to Congress supporting a repeal primarily because the board takes decision-making away from lawmakers regarding Medicare policy.

Mary R. Grealy

But there is no more time to waste, Mary R. Grealy, president of the Healthcare Leadership Council, told FierceHealthcare during an interview Thursday. Congress must act on IPAB before it adjourns for its August recess on July 28. That’s because there is a provision in the law that allows Congress a one-time opportunity to pass a resolution that would permanently end the IPAB process. That resolution, which Grealy says could be fast-tracked through the legislative process without being subject to filibuster or amendment, must be adopted by August 15.

In a letter (PDF) to Congress, coalition members say they are worried because they suspect IPAB will be triggered this year when the Medicare actuaries announce their annual spending projections. The result: significant cuts to program spending in 2019. And those cuts would likely include a reduction in Medicare physician reimbursements, which Grealy said will undermine access to care for seniors and beneficiaries with disabilities as more doctors restrict the number of Medicare patients they treat.

But she said the good news is that the ACA includes an “off ramp” so to speak for eliminating IPAB with a joint resolution of Congress. “What is nice about this mechanism is it’s a clean legislative process and there is bipartisan support for it,” she said.

Indeed, the bipartisan legislation to repeal the IPAB, which is sponsored by congressmen Phil Roe, R-Tenn., and Raul Ruiz, D-Calif., now has 219 cosponsors, a majority of the U.S. House, according to Greely. Now, as the deadline nears, she urges hospital leaders to call their representatives and let them know they support a repeal.

As part of the campaign to overthrow the IPAB, her organization has sponsored a $2 million television, print and digital advertising campaign to raise awareness about the dangers the IPAB poses to Medicare beneficiaries.

Charles W. Boustany

Former Republican congressman Charles Boustany (La.), a former heart surgeon, told FierceHealthcare that his former colleagues in Congress do believe that the IPAB is a blunt instrument that is more a budgetary tool than a mechanism that would contain costs while maintaining or enhancing quality of healthcare. It’s vital that lawmakers address quality and efficiency in delivery of care while bringing costs down to their lowest level, he said, in order to improve patient care.

Vic Fazio, a former Democratic congressman from California, said he believes the fast-track method to eliminate IPAB has the support it needs if it gets on the schedule before the summer recess.

Vic Fazio

Although House Democrats opposed the provision of IPAB when it was enacted as part of the ACA, he thinks many lawmakers forgot about it because no appointments were made to the board and it was never triggered.

But the danger now is that because there is no board, if the mechanism is triggered, HHS Secretary Tom Price will have unilateral authority to make required cuts and there will be no recourse if lawmakers oppose those cuts. That authority, he said, should return to Congress, an authority member should never have given away, he said.  

Below, is one of the television spots the Healthcare Leadership Council is running to raise awareness about the IPAB deadline.