Bills
| 3.23.22

Should Congress Eliminate the Obamacare Board that Suggests Medicare Cuts? (H.R. 849)

Do you support or oppose this bill?

What is H.R. 849?

(Updated April 20, 2019)

This bill would repeal sections of the Affordable Care Act (commonly known as Obamacare) that established an Independent Payment Advisory Board (IPAB) — the group responsible for thinking of proposals to reduce Medicare spending. It would also restore the legal provisions that were repealed to create the IPAB.

The IPAB is a 15-member panel that recommends ways to keep Medicare spending from growing at a faster rate than the targets set by the Centers for Medicare and Medicaid Services (CMS). So, for example, the IPAB would try to reduce projected Medicare spending by 1.25 percent in 2017 and 1.5 percent in 2018 and beyond. IPAB is only triggered when CMS predicts Medicare won’t hit those spending targets and Congress doesn’t act to meet them. That currently isn’t expected to happen until 2021, so IPAB isn’t operational at the moment.

Argument in favor

The IPAB was a terrible idea. They are an unelected panel that recommend spending cuts based on an arbitrary scale. It has too much power — if Congress doesn’t pass legislation meeting their reduction rates — Medicare spending is automatically cut.

Argument opposed

Medicare spending needs to be reined in one way or another, it's increasing every year at an unsustainable rate. The IPAB ensures that the necessary cuts happen, even if Congress can't agree on a bill that’d reduce spending.

Impact

Seniors enrolled in Medicare and their families that’d be affected by cuts to Medicare; Congress; CMS; and the IPAB.

Cost of H.R. 849

A current CBO cost estimate is unavailable.

Additional Info

In-Depth: Sponsoring Rep. Phil Roe (R-TN) introduced this bill to repeal the Independent Payment Advisory Board (IPAB):

“One of the most troubling parts of Obamacare is the Independent Payment Advisory Board (IPAB). If this Obamacare provision is triggered, this unelected, unaccountable board could have a widespread control over Medicare spending, potentially affecting seniors’ access to care without any accountability to Congress or the administration. While we certainly need to take steps to preserve Medicare for future generations, I have grave concerns the IPAB could drastically cut Medicare benefits with little to no Congressional oversight. There is bipartisan agreement in Congress that the IPAB is a gross overreach of power, and I am glad to introduce the House version of these bipartisan, bicameral measures to protect seniors’ access to Medicare while we work to repeal Obamacare as a whole.”

This legislation passed the House Ways and Means Committee on a 24-13 vote and has the support of 268 bipartisan cosponsors in the House, including 224 Republicans and 44 Democrats. During the last session of Congress a similar bill that was endorsed by 500 medical organizations passed the House on a 244-154 vote before stalling in the Senate.


Of Note: During the debate to repeal the Affordable Care Act, the IPAB was characterized as a ‘death panel’ resulting from fears that it would lead to the rationing of healthcare.

While the ACA bans the IPAB from rationing healthcare, there are lingering questions about the legal definition of ‘rationing’. The IPAB could indirectly ration care by cutting the compensation doctors receive for treating Medicare patients. Doctors have cited falling reimbursement rates for treating Medicare and Medicaid patients as a reason for declining to see those patients.

Those that favor keeping the IPAB point out that while it's an imperfect mechanism to restrain Medicare spending, it reduces Medicare spending. If you kill the IPAB, they contend, you put Medicare on an unsustainable trajectory.


Media:

Summary by Eric Revell

(Photo Credit: knape / iStock)