Home Health & Hospice Week

The so-called "Super-MedPAC" established in the health care reform law last year is coming under fire. Under the Affordable Care Act, the Independent Payment Advisory Board (IPAB) could implement the type of cost-cutting recommendations the Medicare Payment Advisory Commission makes without the congressional approval that MedPAC recs currently require. When Medicare spending reaches certain limits, Congress will have to override IPAB recs with a three-fifths majority to stop them from being implemented.

The presidentially appointed board "will surely do more harm than good," says Julie Reiskin of the Colorado Cross-Disability Coalition in a commentary in the Denver Post. "IPAB is dangerously unaccountable and will, without question, restrict access to vital healthcare services."

Provider cuts implemented under IPAB will be "sure to ration care or increase consumer cost sharing," Reiskin says in the newspaper.

"Boards like these serve only to undermine the quality and even the availability of patient care," says a National Review article on IPAB. "If care is going to be rationed ... should it be done by government bureaucrats or should it be patients who get to decide?" Rep. Phil Roe (R-Tenn.) told National Review Online. Roe introduced a bill in January to repeal IPAB, and it has bipartisan support.

Recent sentiments expressed by House Ways and Means Committee Chair Dave Camp (RMich.) are shared by many lawmakers. "I haven't been a fan of the IPAB because it delegates authority to unelected bureaucrats," Camp said at a May 5 Health Affairs Newsmaker breakfast.

But not everyone agrees. Former Bush Administration-era Centers for Medicare & Medicaid Services Administrator Mark McClellan reportedly told POLITICO that the board could generate "a lot of good ideas from experts."

"I don't think we can sustain the Medicare program just by squeezing down prices and not doing other things too," continued McClellan, now director of the Engelberg Center for Health Care Reform at the Brookings Institution.