WASHINGTON – Partisan squabbling from both sides of the aisle was the highlight of 2 days of House committee hearings on the Independent Payment Advisory Board.
“The Affordable Care Act ends the Medicare guarantee; it ends Medicare as we know it,” chairman Paul Ryan (R-Wisc.) said during a July 12 hearing before the House Budget Committee. “Nobody is arguing against capping spending around here. The only difference is, this law empowers the [Independent Payment Advisory Board] with the unilateral power to decide how to live underneath that cap.”
Rep. Paul Ryan (R-Wisc)
Rep. Henry Waxman (D-Calif.) and Rep. Frank Pallone (D-N.J.) defended the health reform law and its capacity to improve Medicare.
“Republicans just assert [that the Affordable Care Act] doesn’t control costs and then they attack the new law’s comprehensive approach it takes to control costs,” Mr. Waxman said during a July 13 hearing of the House Energy and Commerce Committee’s Subcommittee on Health. He argued that Republicans also ignore Congressional Budget Office estimates that the Republican budget proposal could double costs for Medicare beneficiaries once the law is fully enacted in 2022.
The IPAB is a board created by the Affordable Care Act. Slated to start in 2014, the board will consist of 15 members appointed by the president, plus three ex-officio members from the Executive Branch. The IPAB will make yearly recommendation to Congress on how to stay within Medicare budget targets; if Congress does not reject the recommendations by a two-thirds majority or come up with equivalent savings of their own, the recommendations will become law automatically.
Rep. Henry Waxman (D-Calif.)
During rounds of questioning before both committees, Health and Human Services Secretary Kathleen Sebelius drove home the point that the IPAB recommendations would keep Congress in the “driver’s seat,” requiring its approval. Ms. Sebelius also argued in favor of the board’s potential to improve the health care system, and added that the Republican budget plan would do the opposite.
“I think [the IPAB] could look at a lot of the underlying rising costs, and recommend payment strategies that much more closely align what doctors tell me they really want to do,” Ms. Sebelius testified. “I would suggest that the House Republican plan just shifts costs onto seniors and those with disabilities, and does not addresses the underlying costs at all.”
IPAB opponents disagree with the requirement that the House and Senate approve IPAB recommendation by a two-thirds vote. They said that this cedes to the board powers that the Constitution gives to Congress, making the IPAB fundamentally unconstitutional.
Although the board is charged with devising recommendations to reduce costs within Medicare, it lacks the ability to increase revenue or change existing benefits. This is one of the reasons opponents argue against the board’s potential to enact further cuts in provider payments and, in their view, decrease access to care.
Rep. Tom Price (R-Ga.), who is also an orthopedic surgeon, spoke before the committee. “If I’m told by the federal government that I will not be paid for a service, what happens in my presentation of the options to that patient?
“As that treating physician, I may be coerced by the federal government into not even presenting that option to the patient,” Rep. Price said.