The >Independent Payment Advisory Board was created by the 2010 health care law. Last month, in releasing his deficit-reduction plan, President Barack Obama called for increasing the panel's authority, saying it was critical to controlling the costs of Medicare, estimated at $524 billion in fiscal 2010. Republicans and some Democrats have denounced IPAB, saying it will be made up of unelected bureaucrats who will wind up rationing care to Medicare beneficiaries. As the spotlight turns back to the deficit, debates about IPAB are moving front and center. Here's a look at the issues:
What will IPAB >do ?
Beginning with fiscal 2015, if Medicare is projected to grow too quickly, IPAB will make binding recommendations to reduce spending. Those recommendations will be sent to Capitol Hill at the beginning of the year, and if Congress doesn't like them, it must pass alternative cuts -- of the same size -- by August. A supermajority of the Senate can also vote to amend the IPAB recommendations. If Congress fails to act, the secretary of health and human services is required to implement the cuts by default.
Who will serve on the panel?
It will have 15 full-time members, and only a minority of them can be health care providers. The president is required to get suggestions from leaders of both parties in Congress in nominating 12 of the 15 appointees. For the other three, he doesn't have to consult Congress. The members have to be confirmed by the Senate. Obama hasn't nominated anyone yet, but said last month that he hopes to fill the slots with "doctors, nurses, medical experts and consumers." Board members, who will serve six-year terms, are to be paid the salary of senior executives in the federal government -- $165,300 this year -- and cannot hold any other jobs.
Why is IPAB so controversial?
Hospitals, doctors, drug companies and some patients' groups are worried IPAB will recommend reductions in Medicare payments -- which they say already are too low -- and that they won't have the time or ability to counter the cuts during accelerated congressional action. Doctors and drug companies are particularly worried that they'll bear a lot of the burden because hospitals and nursing homes aren't subject to IPAB's cost-cutting recommendations until fiscal 2020. Lawmakers -- mostly Republicans but some Democrats as well -- say that IPAB will have too much power and are pressing for repeal of the provision.
Some critics, including House Budget Committee Chairman Paul Ryan, R-Wis., charge that IPAB will ration needed care for seniors.
Defenders counter that the law bars it from rationing care, restricting benefits or changing eligibility criteria. And, in response to complaints from the health care industry, Sen. John Rockefeller, D-W.Va., who was one of IPAB's architects, said that the board was specifically designed to reduce the influence of "special interests" on Medicare payment policy. Those interests, he and others say, have kept Congress from making the tough decisions needed to hold down spending and reduce the deficit. ..................
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