GOP stalemate may give Sebelius control of IPAB

Republicans urge Kathleen Sebelius to keep away from board
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Congressional Republicans continue to oppose the Medicare Independent Payment Advisory Board (IPAB), but their refusal to submit possible candidates to the new cost-control panel may give the U.S. Department of Health & Human Services secretary the power to determine Medicare cuts.

In a May 9th memo, the Congressional Research Services told Sen. Tom Coburn, M.D., (R-Okla.) that if no one is appointed to the IPAB, HHS Secretary Kathleen Sebelius would be responsible for cutting the $586 billion Medicare program when projected per capita spending outpaced growth targets. "In short, should the IPAB fail to submit a package of recommendations in a required submission year, the secretary is obligated by law to do so," the memo said. "In either event, such legislation would be governed by the 'fast-track' procedures established by" the [Affordable Care] Act."

The fast-tracking measure means IPAB's spending reduction recommendations automatically become law unless Congress replaces them with comparable cuts or the Senate overrules the panel with a two-thirds majority vote, according to American Medical News.

The Independent Payment Advisory Board (IPAB), created by President Obama's healthcare law and set to be established in 2014, was designed to ensure bipartisan input. Once established, the IPAB would make targeted cuts in Medicare's payments to doctors and other providers if overall spending grows faster than a certain rate. Although Obama asked congressional leaders from both parties to submit nominees for the IPAB, Republicans refused to recommend anyone, claiming that reduced payments will result in providers refusing to see Medicare patients, which will lead to access problems, waiting lists and denied care for seniors.

"We believe Congress should repeal IPAB, just as we believe we ought to repeal the entire healthcare law … We hope establishing this board never becomes a reality, which is why full repeal of the Affordable Care Act remains our goal,"  wrote John Boehner (R-Ohio) and Senate Majority Leader Mitch McConnell (R-Ky.) in a letter to Obama.

But Republican lawmakers are urging Sebelius to keep her distance from the IPAB due to the controversy over her asking the healthcare industry to donate money to help the Obama administration promote the reform law and the health insurance exchanges, in particular, The Hill's Healthwatch reports.

In a May 24 letter, Republicans Sen. John Cornyn (Texas) and Rep. Phil Roe (Tenn.) asked Sebelius to not use her power to take the place of the IPAB if Republicans successfully block it. "At a time of diminished trust in government, it is imperative that we make all efforts to eliminate any appearance of favoritism," they wrote.

To learn more:
- read the Congressional Research Services memo (.pdf)
- see the amednews article
- check out the Healthwatch blog post
- read the May 24 letter (.pdf)

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