Repealing and Replacing IPAB with Better Solutions

The Independent Payment Advisory Board (IPAB) was created by Congress as part of the Patient Protection and Affordable Care Act (PPACA) as a means of containing Medicare spending. The IPAB was designed to take difficult decisions about Medicare payment reductions out of the legislative process and delegate them to a panel of independent experts. These 15 experts, to be appointed by the president and confirmed by the Senate, will have the authority to make binding recommendations to make cuts in Medicare payments if per capita spending exceeds defined targeted rates.  The board’s recommendations will be sent to Congress at the beginning of each year for fast-track consideration.

PPACA gives the Congress a route to override the IPAB’s recommendations, but it raises the bar on the legislative processes in a way that will make it difficult for Congress to intercede. Congress can override or amend the board’s recommendations only with a supermajority vote in both houses, and it has a limited time period to pass legislation with alternative cuts that would meet the spending targets. If Congress does not act in the required timeframe, the secretary of Health and Human Services is required to implement cuts to reach the targets.

Clearly, the IPAB is unprecedented in the power given to unelected officials to direct hundreds of billions of dollars in federal spending. The IPAB will give unelected, unaccountable government appointees the power to make decisions about payment policy in Medicare that will ultimately determine whether millions of seniors have access to the care they need.


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