At least one person in Congress is in no hurry to get rid of the Independent Payment Advisory Board.
Despite urging from healthcare trade groups that Congress approve a joint resolution to eliminate IPAB by Aug. 15, Rep. Anna Eshoo, D-Calif., said she doesn’t think her colleagues in the House of Representatives should rush to do it, especially because there is no immediate threat that Medicare spending is too high and cuts need to be made. Indeed, the latest Medicare Trustees report said that the need for an IPAB panel won’t occur until 2021.
Eshoo made the remarks Thursday during a House Energy and Commerce Committee Subcommittee on Health hearing on bipartisan legislation to improve the Medicare program.
Although she agrees that Congress should ultimately be in charge of Medicare policymaking, Eshoo likened the panel to the Base Realignment and Closure (BRAC) Commission. Congress collectively didn’t have the political will to close military bases, so it established the commission. And, she said, the process worked well.
“There are many sensitivities to decisions relative to Medicare,” she said, noting that a commission to advise Congress could consider all the interests of panelists that submitted testimony at Thursday’s hearing, including the Diabetes Patient Advocacy Coalition, the ALS of Michigan, American Academy of Home Care Medicine, CHIME, Healthcare Leadership Council, American Physical Therapy Association, the National Association for the Support of Long Term Care and the National Home Infusion Association.
“Each has a great case but no one talked about how we will pay for the darned thing,” she said. Eshoo said she believes a commission that represents all stakeholders should make recommendations and Congress should accept or reject the advice.
But Congressman Raul Ruiz, D-Calif., who has cosponsored the bipartisan legislation to repeal the IPAB with Phil Roe, R-Tenn., said that though the requirement for the IPAB to lower Medicare costs was well intended, it focuses on cutting payments instead of strengthening the program through cost savings. Furthermore, he said, if the mechanism leads to arbitrary physician payment cuts, it may create patient access issues. “Specifically, he said, “if physician reimbursement under Medicare is so low they may have to stop accepting Medicare patients.”
The focus, Ruiz said, must be to rein in out-of-control healthcare costs, the primary reason insurance premiums continue to rise.
Despite Eshoo’s belief that there is no immediate need to address the IPAB trigger, Mary R. Grealy, president of the Healthcare Leadership Council, a coalition of 700 healthcare groups, told the panel that lawmakers can’t afford to wait. That’s because a provision in the Affordable Care Act allows Congress a one-time opportunity to pass a joint resolution to permanently end the IPAB process without being subject to a filibuster by amendment. And Congress only has until Aug. 15 to take advantage of the provision.
Otherwise, since neither President Obama nor President Trump has appointed anyone to the 15-member IPAB, if the mechanism is triggered, the law gives the authority to the sitting secretary of Health and Human Services (currently Tom Price) to make the required cuts.
No one person, regardless of party affiliation, should have that authority, Ruiz said, and neither should unelected appointees who aren’t accountable to the American people.
See the video below to watch the full hearing: