Marian Benjamin

The Independent Payment Advisory Board (IPAB), one of the key provisions in President Obama’s health care reform law, is being met with overwhelming opposition by House Republicans (and several Democrats), who are supporting a bill to get this provision of the Patient Protection and Affordable Care Act (ACA) repealed.1 The ACA sets out specific growth rates for Medicare, and the IPAB is charged with ensuring that Medicare expenditures stay within these limits. The IPAB will also recommend ways to control health care costs more generally.2

The IPAB will comprise 15 members appointed by the president for 6-year terms. The members will be nationally known experts in health finance, payment, economics, or actuarial science, or health facility and health plan managers, who will represent providers, consumers, and payors.2

Why are legislators so against IPAB? Isn’t it a good thing to try to cut Medicare spending? Well, yes, but the IPAB was never included in the original version of the ACA.3 It was inserted at the last minute without, some say, proper legislative review. It will give the 15-member panel unprecedented power to control health care spending with virtually no congressional oversight. Although the board will have to submit a proposal to Congress every year, Congress will not be able to add amendments unless they meet the same cost-reduction goals as the IPAB plan. Any resolution to abolish the IPAB must pass both houses of Congress; and the resolution cannot be introduced before 2017 or after February 1, 2017, and must be enacted by August 15 of that year.4 If passed, it cannot take effect until 2020. This would effectively entrench IPAB, making it impossible for another Congress to alter or abolish it.

What could the consequences be if the IPAB proposal goes into effect? Although there is language in the proposal that there will be no rationing of care, one wonders how, then, costs will be cut? IPAB will make recommendations to limit costs by limiting reimbursements to physicians. This could result in physicians leaving the Medicare system, thus limiting access to care for seniors. Will the price controls lead to one-size-fits-all rationing? Will the elderly be unable to obtain care or experience treatment delays and declines in quality of care?

Unless the provision is repealed, your facility will be impacted by IPAB “recommendations” before too long. Will the IPAB provision change the way you are allowed to provide care for the sickest of your elderly patients? Guess we’ll find out.

—Marian Benjamin


  1. Haberkon J. Medicare pay board is losing support. Available at: [removed][/removed]. Accessed June 25, 2011.
  2. Jost TS. The Independent Payment Advisory Board. Available at: Accessed June 25, 2011.
  3. Kurtz S. IPAB, Obama, and Socialism. Available at: Accessed June 25, 2011.
  4. Will GF. How Obama health plan sidesteps Constitution. Available at: Accessed June 25, 2011.