Hidden in the labyrinth of the Patient Protection and Affordable Care Act (ACA)—ObamaCare, for short—is a provision that symbolizes the mandatory theme that characterizes the entire nationalized health scheme. The provision creates an appointed board of “experts” with power to dictate cost policies and timing to Congress and to cap health-care spending.
Eventually, patients, doctors, and hospitals will be under the sway of this board. It’s called the Independent Payment Advisory Board (IPAB). There’s an odor, not only of independence but also of arrogance, about this board’s authority and function. The chief actuary for Medicare will estimate costs in the spring of 2013. The IPAB will then begin its work to make its own decisions by 2015.
By then, many new health-care revisions could be in place. Certainly that’s the hope of most Americans. But the powers presently granted to the nascent IPAB reveal the mentality and intent of the drafters and supporters of ObamaCare. They are not comforting.
The Star Chamber-like operations of the IPAB can be seen in the fact that only if three-fifths of the Senate—a supermajority—vote against implementing a decision of the IPAB can its decisions be blocked. Further, the implementations of the Board’s dictates are exempt by law from administrative and even from judicial review.
Peter Orzag, who was then head of the Office of Management and Budget, gloated over the IPAB’s power in a talk at the Economic Club of Washington. He said it has “an enormous amount of potential power…its proposals take effect automatically if Congress ignores them or if Congress votes them down and the President vetoes that bill…inertia plays on the side of this independent board.”
In the New England Journal of Medicine, Washington & Lee University Law School Professor Timothy S. Jost writes that health reform debate for some time has included what is seen as a unit of experts to oversee the health-care system. Supposedly “market forces alone, it is argued, cannot control health-care costs, and Congress is too driven by special-interest politics and too limited in expertise and vision to control costs.” So, summon the experts!
What the new, more bipartisan Congress will do about ObamaCare is not yet defined. Tea Party lawmakers are balking at some House GOP leaders’ plans to simultaneously repeal and replace ObamaCare, TheHill.com reported Dec. 1. They say they want repeal followed by a debate to determine just what the best replacement provisions should be.
Republicans in their Pledge to America this fall called for replacing odious portions of the law. But there is some support for keeping the few popular provisions, such as barring discrimination because of pre-existing health conditions. A full repeal is highly unlikely because, even if it should slip by the Senate, Obama surely would veto a total repeal.
The American Medical Association called the Independent Payment Advisory Board one of the most controversial elements in the Act. The doctor organization said it is opposed to the current scope and authority of IPAB and the lack of flexibility in its mandate. The Congressional Budget Office (CBO) figures a cut in Medicare spending of about $16 billion from 2010 to 2019. This creates anxiety at AMA. The organization fears that physicians will bear the brunt of cuts.
The 15-member Independent Payment Advisory Board is to be appointed by the President. Their terms will be for six years. So, these unelected bureaucrats will be in office even after Obama is gone. It would be made up of health-care experts and economists tasked with developing Medicare cuts in years during which spending exceeds a target growth rate based on the Consumer Price Index. IPAB decisions will take effect yearly beginning in 2015. If Congress fails to pass cost savings each year by Aug. 15, it must abide by the board’s edicts. The IPAB’s orders will automatically take effect.
The members of the IPAB will have full-time jobs at a level 3 executive department pay. As Professor Jost writes: “Many questions remain about how, and indeed whether, the IPAB will work. Staffing the board with 15 leading experts who are willing to give up research, practice, and teaching for six years for a relatively modest salary will be a challenge.” Unless, that is, they are people who yearn for unaccountable bureaucratic power.
The law says that Congress cannot consider any amendment to the board’s proposal that does not meet the same cost-reduction goals, and if Congress fails to adopt any substitute provision complying with the statute by August 15 each year, the Department of Health and Human Services must implement the board’s proposal. The law says IPAB may not ration health care, raise costs to beneficiaries, restrict benefits, or modify eligibility criteria. But provisions of many laws have been twisted to suit political wishes.
One person almost sure to be on the board will be Dr. Ezekiel Emmanuel, who helped draft ObamaCare. He has made a career of calling for reallocation of “scarce medical interventions” from the relatively worthless elderly to those with greater benefit who can be “fully productive in society.”
While designed to restrict the growth of Medicare, the board could influence decision on all aspects of health care. The IPAB must submit to Congress “recommendations regarding ways of slowing the growth of private national health care expenditures,” as Professor Jost explains. And the board must also make recommendations—or tell—Congress “how to control health care costs more generally.”
Why, one might ask, were the target dates in the IPAB provision for particular providers—hospitals, unions, insurers, and physicians, for example–stretched out to not take place until 2020. The obvious explanation is: The health bill would not have squeaked through Congress without the cooperation and capitulation of affected interest groups.
To reduce their pain a bit, deals were cut—payoffs. That’s the way the Democrats who wrote the bill operate.