The AADA supports the Protecting Seniors’ Access to Medicare Act. This legislation was introduced in January 2013 and would repeal the Independent Payment Advisory Board (IPAB). The AADA strongly supports this repeal because implementation of the IPAB would largely remove congressional authority over Medicare and grant unprecedented authority to an un-elected panel of officials.
Read the letter that the AADA sent to lead sponsor and author of the bill, Rep. Phil Roe.
Read the letter that the AADA sent to co-sponsor Rep. Allyson Schwartz.
During the 112th Congress, members in both chambers introduced HR 452 and S 668 to repeal the IPAB. Read the letter that the AADA sent to Rep. Phil Roe, sponsor of HR 452.
The Patient Protection and Affordable Care Act calls for the establishment of an Independent Payment Advisory Board (IPAB). The IPAB is charged with formulating comprehensive regulatory and legislative recommendations designed to slow the growth in national health spending while preserving or enhancing quality of care. It will have the authority to make binding Medicare policy recommendations and non-binding private payer policy recommendations to Congress.
The President will appoint the board's 15 members. These board members may seek advice or consent from the Senate as well as the Secretary of Health and Human Services, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration. The Senate Majority and Minority Leaders, the Speaker of the House, and the House Minority Leader may nominate three members each to the IPAB.
The board is designed to include individuals who have national recognition for their expertise in health finance and economics, actuarial science, health facility management, health plans and integrated delivery systems, and reimbursement of health facilities. Members should represent a mix of professionals who span a broad geography with a balance between urban and rural representation.
The IPAB will include allopathic and osteopathic physicians; other health professionals; other providers of health services; experts in the area of pharmaco-economics or prescription drug benefit programs; employers; third-party payers; individuals skilled in the conduct and interpretation of biomedical, health services, and health economics research; and individuals with expertise in outcomes and effectiveness research, and technology assessment. Given the mix of membership, physicians will not be in the majority.
Members will have six-year terms with a limit of two full consecutive terms.
The IPAB may start submitting to Congress advisory reports on matters related to the Medicare program as soon as Jan. 15, 2014. The annual proposals would focus on limiting Medicare spending on a per capita basis, to a fixed growth rate, initially set at a mix of general inflation in the economy and inflation in the health sector. Starting in 2018, the upper limit is set permanently at per capita gross domestic product growth plus 1 percentage point. Hospitals are exempt from IPAB until 2019.
By July 1 of the same year, the IPAB will produce a public report containing standardized information on system-wide health care costs, patient access to care, utilization, and quality of care. This report will allow for comparison by region, types of services, types of providers, and both private and public payers. The board is charged with producing such a report annually thereafter.
To hit its budgetary targets, the IPAB is strictly limited in what it can recommend and implement. It can't "ration care" or change the benefits, but it could cut Medicare payment rates for those providing services to the beneficiaries.
Beginning in 2015, the IPAB will have the authority to make Medicare cost-reduction recommendations. By Jan. 15 of that year, the board will submit to Congress and the President its recommendations. It also will submit recommendations at least once every two years thereafter.
Some suggest that empowering the IPAB with the authority to make binding Medicare policy recommendations based on expenditure targets inflicts physicians with an additional expenditure constraint in addition to the sustainable growth rate formula.