Bioethics Blogs

Disparaging Remarks about the IPAB

Whatever its merits, the Affordable Care Act (ACA) will not be fully repealed, for at least political and practical reasons.  But one feature of it that needs to go is the Independent Payment Advisory Board (IPAB), intended to be a panel of 15 appointed experts for whom IPAB is in essence their full-time job.  (As of this writing, no members have been appointed or even proposed by the president.)  Created (as I understand it) to try to provide some guidance on how to control Medicare spending in a way that is less beholden than the current Medicare Payment Advisory Commission (MedPAC) to a Congress bedeviled by special interests, the more I read about IPAB, the more I am convinced it is a hastily- and poorly-conceived monster.

I shan’t shower you with links (they abound on the Internet), but among the issues, as I understand them:  “recommendations” automatically become binding on the Secretary of Health and Human Service (HHS) if Congress, in conjunction with the President, does not revise them promptly; making changes requires a three-fifths majority of the Senate in any event; if IPAB fails to issue recommendations, the Secretary of HHS is supposed to do that unilaterally; IPAB spending prescriptions may in fact extend far beyond Medicare, potentially retaining the same force of law; once empaneled, IPAB cannot be done away with except for a 7-month window in 2017 in which three-fifths of both houses of Congress must agree—and after that, all IPAB decisions become enforced without further review of any sort; and there is no judicial review allowed, making IPAB’s decrees entirely free from review by the executive, legislative, or judicial branches.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.