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 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 decision-making 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.
Already, the number of physicians unable to accept new Medicare patients due to low
reimbursement rates has been increasing over the past several years (with almost one of every
three primary care physicians, according to the American Medical Association, restricting the
number of Medicare patients in their practice). 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 decision-making 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
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