Section 3403 of the Patient Protection and Affordable Care Act (PPACA) established the Independent Payment Advisory Board (IPAB), responsible to reduce the per capita rate of growth in Medicare spending. IPAB is a panel of 15 independent, unelected bureaucrats with unilateral authority, whose decisions are freed from judicial and administrative review. Congress cannot delegate away it's legislative responsibilities under the Constitution. The decisions of IPAB will most certainly cut payments to physicians under Medicare, limit patient access and quality to medical care.
Doctor Patient Medical Association is not supportive of the IPAB and urges repeal. DPMA recognizes there is a problem with Medicare spending and need for savings, but IPAB is not the right approach. Private contracting, tort reform, permitting charity care will provide the stability and certainty that physicians and patients need.
Independent, Unelected Bureaucrats 15 member panel, 12 of whom are appointed by the President. Individuals who are directly involved in providing or managing care "shall not" constitute a majority of the board's members. Members serve six-year terms, become salary federal employees as senior executives ($165,300 anticipated at 2011 rates) and cannot hold any other jobs.
Unilateral Authority The decisions cannot be challenged in the courts and are freed from the normal administrative rules process - require no public notice, public comment or public review. IPAB "recommendations" carry the full force of the law, unless 2/3 of the House and Senate vote to override.
Decisions Will Impact Physicians & Patients The board is specifically forbidden from "any recommendations to ration health care", but PPACA fails to define the word "ration" and leaves the opportunity for IPAB to adjust physician reimbursement rates below costs, which in essence would constrict a physician's ability to treat patients, likely resulting in less physicians accepting Medicare, affecting the access to care and increasing patient wait times for routine and emergent care. The IPAB is also forbidden from raising premiums for Medicare beneficiaries or increase deductibles, coinsurance or co-payments, cannot change who is eligible for Medicare, restrict benefits or make recommendations that would raise revenue.
Absolves Congress IPAB is intended to take tough decisions about Medicare spending out of the purview of Congress, in effect, delegating away it's legislative responsibilities under the Constitution. Congress has repeatedly failed to hold Medicare spending in check, resulting in an expected Medicare insolvency projected in 2024.
The Medicare Payment Advisory Commission (MedPAC) already exists, an agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program. The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.
IPAB was simply created to absolve Congress of having to make decisions that directly impact the quality and access of care for Seniors, and also insulate them from having to make tough decisions.
House Republican Policy Committee Chairman Tom Price, M.D. (R-GA) questioned witnesses at a Ways and Means Health Subcommittee hearing on how IPAB will threaten the integrity of our health and retirement security system by putting bureaucrats in between patients and their doctors.
Physicians reacted with shock and anger to the Supreme Court’s decision to uphold the President Obama’s health care law, according to poll data and the leaders of activist groups, which are continuing to fight the law in court and via political action.
According to Kathryn Serkes, cofounder of the Doctor Patient Medical Association, a recent nationwide poll sponsored by her organization found 83 percent of U.S. physicians have considered leaving their practices due to President Obama’s law.
“This not just something that started today, and it’s not something that just started with passage” of Obama’s law, said Serkes. “There have been developments in medicine that have made it very, very difficult and have put some seriously different pressures on doctors. But this bill has certainly brought things to a head.”
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