HHS Secretary Sebelius and Rep. Paul Ryan are Both Right on IPAB
It’s “IPAB Beat-Down Week” in DC with no fewer than 4 Congressional hearings scheduled on the Independent Payment Advisory Board (IPAB), the controversial Medicare cost-cutting group established in health reform.
IPAB was established as an expert “backstop” in case Congress couldn’t agree on methods to contain Medicare costs in the future. The 15-member board will recommend cuts in Medicare payments to doctors, which will take effect automatically unless Congress votes to block them. The idea of some shadowy unelected group that could “ration” services to Medicare beneficiaries drives Congressional Republicans guano-insane.
The Hill reports on last week’s fireworks between HHS Secretary Kathleen Sebelius and Rep. Paul Ryan (R-WI), Chairman of the House Budget Committee and author of the equally-controversial GOP proposal to reform Medicare into a sort of voucher program that passed the House but failed in the Senate:
“IPAB’s power is only triggered if Medicare spending exceeds a certain rate. So lawmakers worried about handing over control of Medicare payments to an unelected board can avoid that scenario by controlling Medicare costs before the IPAB is in place, Sebelius said. “If Congress is actually paying attention to the bottom line of Medicare, IPAB is irrelevant.”
Sebelius defended IPAB against charges of rationing, noting that the ACA prohibits IPAB from cutting benefits or shifting costs to seniors.
Ryan said as IPAB cuts payment for particular services, fewer doctors will offer them to Medicare patients, and eventually care will become unavailable. “Isn’t that effectively rationing in and of itself?” Ryan asked.
Sebelius conceded Ryan’s argument that Medicare spending is unsustainable on its current trajectory, a problem he says calls for a major overhaul, such as his plan to reform the program. Letting seniors choose among private health insurance plans is better than empowering the IPAB to cut doctors’ rates, Ryan argued.”
They’re both right. But will Congress have the will to reform Medicare and avoid IPAB’s intervention? Probably not, if the ongoing saga of the Sustainable Growth Rate for physicians or the sorry state of negotiations on the debt ceiling are any indication.