Of the controversial elements of the president’s health reform law, the provision with perhaps the most bipartisan opposition is its Medicare cost-containment board.
The Independent Payment Advisory Board, sometimes called a “rationing board” or “death panel” by its detractors, is designed to help control Medicare spending. Its 15 Senate-confirmed members have the authority to craft new Medicare payment policy with the force of law if costs grow faster than a specified rate.
What many critics don’t realize is that if that 15-person board is not assembled, the law hands a lot of power to the secretary of Health and Human Services.
Detractors in Congress don’t like it because it takes away their power to set Medicare policy and gives it to “unelected bureaucrats.” It is worth noting that the law specifically prohibits the board from rationing care, eliminating benefits, or increasing out-of-pocket costs for seniors. On Wednesday, a bipartisan group of House members introduced legislation to eliminate it. Its prospects of Senate passage are nil, but the bill is likely to reignite criticism of the board. (House Republicans have already passive-aggressively expressed their distaste for IPAB by writing rules that would ignore its existence.)
That may not be as bad for the White House as the board’s critics believe. The political heat the board is receiving could create a result that lawmakers will like even less than the status quo. Though the board has been funded for a year, the president has not yet named a single person to serve. Commentators have been saying that the IPAB’s infamy could make it hard to find volunteers, even if the president wanted to name names. Some may see that as a triumph. But failing to name (or confirm) a board may leave the president with even more power to steer Medicare payment policy from the executive branch.
That’s because the law doesn’t actually eliminate the board’s power if the board doesn’t exist. A provision tucked away in the Affordable Care Act creates a backup plan if the board can’t issue any of its required recommendations. (See section (C)(5) here.) The IPAB’s power, if not used by a board, will be transferred into the hands of the Health and Human Services secretary, currently Kathleen Sebelius.
The good news for IPAB haters and lovers alike is that the board will have very little to do in the next few years. Recent updates from the Centers for Medicare and Medicaid Services show that Medicare costs are growing at an extremely low rate. If that trend holds up, there will be no need for a board, or a super-powered secretary, to begin cutting away at the Medicare budget. Congress will get to wield that power, if it wants to use it, in the coming deficit fight.