Repeal the Independent Payment Advisory Board (IPAB)
In 2010, the Patient Protection and Affordable Care Act (PPACA [P.L. 111-148]) created the Independent Payment Advisory Board (IPAB), a board appointed by the President and empowered to make recommendations to cut spending in Medicare if its spending growth reaches certain arbitrary levels.

Over the last several years many of you have been supportive of efforts to repeal IPAB. To that end, there has been success in building support for repeal through co-sponsorship of IPAB repeal legislation, hearings, votes, teletownhalls, media, and our previous large group sign-on letter efforts.

While IPAB action has not been seen as imminent in past years, this provision is of such concern that it still needs to be repealed. There is a sense of urgency since the next Medicare Trustees report is expected to trigger IPAB into action and lead to proposed cuts in Medicare expenditures that would be extremely difficult for Congress to overturn.

We remain greatly concerned with the impact IPAB will have if implemented. If you share our concerns, please consider adding your organization's name to the letter to Congress below.

Letter

Dear Member of Congress:

The undersigned organizations – representing Medicare beneficiaries and patients, all sectors of the healthcare industry as well as employers and other purchasers of health care – believe strongly that the Medicare program must protect patient access to quality healthcare. The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decisionmaking responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.

IPAB, as constructed under PPACA, is a board comprised of Presidential appointees who will be charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level. Once the Secretary of Health and Human Services (HHS) implements an IPAB recommendation, that action is not subject to administrative or judicial review. As constructed, IPAB is granted unprecedented powers – even the ability to change laws previously enacted by Congress – with virtually no oversight.

The potential impact of this board causes deep concern among our organizations and the millions of Americans we represent. IPAB proponents suggest that the board will be an asset in developing needed healthcare delivery reforms. That goal, however, is not realistically achievable. The law requires IPAB to achieve scoreable savings within a one-year time period. Thus, instead of pursuing long-term reforms that may not achieve immediate savings, IPAB is more likely to consider short-term savings in the form of payment cuts for healthcare providers. This was, in fact, the conclusion of the Congressional Budget Office, which stated that IPAB is most likely to focus on payment rates or methodologies for services provided by non-exempt providers.

This would be devastating for patients, affecting access to care and innovative therapies. IPAB-generated payment reductions would only increase the access difficulties faced by too many Medicare beneficiaries. Furthermore, payment reductions to Medicare providers will almost certainly result in a shifting of health costs to employers and consumers in the private sector.

Under IPAB’s provisions, the responsibility for enacting healthcare system changes of this magnitude would be transferred from the legislative branch to the executive. More specifically, an unelected board without adequate oversight or accountability would be taking actions historically reserved for the public’s elected representatives in the U.S. House and Senate. This is an unacceptable decisionmaking process for a program that millions of our nation’s seniors and individuals with disabilities rely upon.

Moreover, if IPAB does not act within the law’s required timeframe or if IPAB members are not appointed by the President or confirmed by the Senate, the law transfers IPAB’s responsibilities solely to the HHS Secretary. This places an enormous degree of power in the hands of one unelected individual.

We strongly support bringing greater cost-efficiency to the Medicare program. We also advocate continuing efforts to improve the quality of care delivered to Medicare beneficiaries. The Independent Payment Advisory Board will achieve neither of these objectives and will only weaken, not strengthen, a program critical to the health and well-being of current and future beneficiaries. We urge Congress to eliminate the IPAB provision.

Sincerely,

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