The director for the CBO and OMB stated that: "IPAC is probably the most important aspect of the ACA" so it stands to reason the Republicans would want to attack it. He said the board was "created to help address our long-term fiscal imbalance while boosting quality in health care". There is a big difference between the IPAB and MedPAC - (which by the way, the GOP tried to repeal as soon as it was created) in that MedPac makes recommendations to congress who then must act to pass legislation (or not). In fact MedPAC had recommended cuts totaling "hundreds of billions of dollars" to Medicare that went ignored by the GOP controlled Congress. IPAB has the authority to enact regulations on its own, but Congress has the right to repeal if it so chooses. Republicans can't repeal the ACA, so they keep going in the back door, flying under the radar dismantling it bit by bit. Then when it does become dysfunctional they can say: See, we told you it would fail. But there is a big difference between the law failing on its own accord and being purposely sabotaged. What happened to the days when legislators respected the laws enacted by the body as the "law of the land" and worked to insure its success even if they didn't personally vote for it? The GOP is literally playing with fire that has real world, life and death, consequences for the citizens of this country. Not to mention the potential damage they could do to a huge sector of the economy in the process. But for some reason they seem hell-bent on doing stand they simply don't care. Nobody ever said the ACA was a perfect bill. There are things that can be done to strengthen it and make it better, but until the voters give the Republican party a wake up call, they are going to continue doing everything they can to destroy our government and the safety all the nets (including Medicare and Medicaid) enacted since the "New Deal" from the inside. They have proved themselves, time and again, not worthy to sit in those hallowed halls, and must be held accountable!