On Nov. 2, the House of Representatives overwhelmingly passed bipartisan legislation, H.R. 849, the Protecting Seniors’ Access to Medicare Act of 2017, to repeal the controversial Independent Payment Advisory Board (IPAB) by a vote of 307–111.
Created by the Patient Protection and Affordable Care Act (PPACA), IPAB is a 15-member board compromised of appointees who will be charged with making recommendations to cut Medicare expenditures if spending growth exceeds certain thresholds. If future Medicare spending is expected to exceed these statutory targets, IPAB will then propose recommendations to Congress and the president to reduce growth.
The American College of Radiology (ACR) strongly supports IPAB repeal as it stressed in letters to the House Energy and Commerce Committee and House Ways and Means Committee. The ACR urged the Senate to expeditiously pass this bill as well.
Both Democrats and Republicans oppose IPAB due to statutorily mandated “fast track” legislative procedures that are designed to ensure Congress quickly implements its pending recommendations. IPAB proposals automatically become law unless three-fifths of the Senate votes against the recommendations or if Congress passes legislation that changes the manner in which IPAB achieves the targeted savings. Otherwise, the legislative branch is prohibited from passing bills that potentially save fewer Medicare dollars than originally stipulated by IPAB. In addition, IPAB recommendations are not subject to executive or judicial branch review.
Complicating viewpoints towards IPAB is the fact that no one has been confirmed to serve on the panel. Neither former President Barack Obama nor President Donald Trump has nominated anyone to serve on this controversial board. Obama decided against wasting political capital on IPAB nominees with the knowledge his nominations would result in many long, politically damaging Senate confirmation fights, which would likely prove unsuccessful. To date, Trump continues to avoid IPAB nominations due to his desire to fully repeal PPACA, and his fundamental disagreement with transferring legislative authority to an unelected panel.
The lack of nominees, however, does not preclude the implementation of statutorily mandated draconian cuts to Medicare reimbursement when the fiscal thresholds are breached. If the president or Senate fail to either appoint or confirm IPAB nominees, PPACA mandates that the secretary of Health and Human Services (HHS) develop and submit legislative proposals for reducing Medicare spending to Congress. The proposals solely developed by the HHS Secretary are also granted the same fast-track legislative procedures reserved for IPAB.
Introduced by Reps. Phil Roe, MD (R-TN) and Raul Ruiz MD, (D-CA), H.R. 849 is a rare bill in that it has generated strong bipartisan support — with 270 members of Congress, including 45 Democrats, listed as cosponsors — though it substantially modifies a key aspect of PPACA.
Since the IPAB repeal is designed to curb long-term Medicare spending, the Congressional Budget Office estimated that repealing this controversial panel would result in a net loss in federal revenue. House Republicans ultimately elected to add the cost of eliminating IPAB to the federal debt.
In the Senate, Republicans and Democrats are pushing separate bills, though the texts of the two bills are essentially identical. Sen. John Cornyn (R-TX) is the lead sponsor for the official companion bill to the Protecting Seniors’ Access to Medicare Act, S. 260. Sen. Ron Wyden (D-OR) introduced S. 251, the Protecting Medicare from Executive Action Act of 2017. Support for both bills falls along party lines with S. 260 generating 37 Republican cosponsors and S. 251 securing 13 Democratic cosponsors. No member of the opposing party is a cosponsor of either S. 260 or S. 251. It was unclear on Nov. 3 whether the Senate can identify bipartisan offsets or if either bill will receive a floor vote.