IPAB Dissent Disregards Party Lines

It’s worth noting that, in the same week that President Obama cited the Independent Payment Advisory Board (IPAB) as a key tool in cutting future Medicare costs, a House Democrat known for her expertise on healthcare issues went public with her belief that IPAB is a bad idea that should be repealed.

In fact, Representative Allyson Schwartz (D-PA), co-chair of the New Dems Health Care Task Force, said she would support Representative Phil Roe’s legislation to do away with IPAB.  She’s not the first member of her Democratic caucus in the House to do so.  Fellow Democratic Representatives Shelley Berkley (D-NV), Michael Capuano (D-MA) and Larry Kissell (D-NC) have already cosponsored the bill.

IPAB was created by the Affordable Care Act.  The board would have the power to make Medicare spending reduction recommendations if program expenditures exceeded the per capita gross national product plus one percent.  If Congress didn’t vote down the IPAB recommendations, they would automatically take effect. In President Obama’s deficit reduction proposal, he would give IPAB even greater authority, lowering the spending threshold at which the board’s powers would kick in.

Schwartz’s reasons for opposing IPAB are good ones.  First, it transfers decisionmaking over healthcare policy from members of Congress to an unelected commission, placing an unwanted layer of bureaucracy between patients, healthcare providers and their elected representatives.  In Schwartz’s words, it would “undermine our (Congress’s) ability to represent the needs of seniors and disabled in our communities.”

She also said that she “cannot condone the implementation of a flawed policy that will risk beneficiary access to care.”

That, I believe, is the greatest knock against the IPAB concept, as it’s drawn up in the health reform law.  Rather than develop innovative ways to deliver high quality, cost effective care to Medicare beneficiaries, IPAB is simply about chopping spending levels downward.  At a time in which likely physician shortages are on the horizon, it makes little sense to “fix” Medicare by cutting payments.  As Alex Valadka, a neurosurgeon, said in National Journal, “Doctors cannot continue to ably treat Medicare patients if they are constantly wondering whether or not the money will be there to reimburse them.”

Yes, we do need to take steps to place Medicare on a sustainable course, but as Congresswoman Schwartz and others so ably point out, IPAB is the wrong tool to pursue that objective.