KHN’s Mary Agnes Carey talks with Jackie Judd about the latest movement in House Republican efforts to repeal a key part of the health reform law — the Independent Payment Advisory Board. One House committee passed a repeal of IPAB Tuesday while another held a hearing on it. The full House is expected to vote on a repeal of IPAB as early as the end of March.
JACKIE JUDD: Good Day, this is Health on the Hill. I’m Jackie Judd. House Republicans are moving towards bringing a bill to the floor to repeal IPAB—the Independent Payment Advisory Board created in the health reform law. Board members would be responsible for reducing Medicare spending if that spending exceeds a target growth rate and Congress does not take action on its own. The House Ways and Means Health Subcommittee held a hearing this morning. Both sides were heard from.
Covering the story is Mary Agnes Carey of Kaiser Health News. Mary Agnes, what did you hear?
MARY AGNES CAREY: Republicans who oppose IPAB talked a lot about how it’s rationing of care, these are unelected bureaucrats, patients wouldn’t be able to appeal their decisions, and that IPAB will have little flexibility other than to simply cut provider payments. And hospitals are exempt from cuts in IPAB until 2018, so the thought is other providers, including physicians, could get cut and that will hurt access to care.
JACKIE JUDD: And what Democrats spoke in support of IPAB?
MARY AGNES CAREY: Several Democrats talked about IPAB as a backstop in the health care law. That it only kicks in if health care spending goes beyond a certain target and they feel that the changes in the health care law for Medicare spending will help stabilize the increase in costs and actually reduce health care costs. And that IPAB is simply there as an insurance policy, if you will, in case costs go beyond that target.
JACKIE JUDD: When Secretary Sebelius was on Capitol Hill last week testifying, she estimated that it might not be until 2018 that IPAB might have to step in. What were the estimates you heard today about when that kind of action might need to be taken?
MARY AGNES CAREY: What I heard today was that Medicare spending might not go beyond the target growth rate until 2020 or 2021. And that would also give, if that, in fact, plays out that way, that would give IPAB plenty of time to look at the health care system to think about approaches and changes that it could possibly make. But one thing to remember here, is the Congressional Budget Office, which Congress abides by, is the scorekeeper that’s predicting that perhaps the target wouldn’t get hit until 2021. The Centers for Medicare and Medicaid Services Office of the Actuary would be the one making the estimation of when the target is hit, when the IPAB trigger would kick in. And often, the Office of the Actuary at CMS and the Congressional Budget Office disagree on estimates, so we could see some movement there.
JACKIE JUDD: Mary Agnes, as you know, the attack on IPAB is part of the larger opposition by Republicans to the health reform law. Are you hearing anymore talk on Capitol Hill these days about repealing the health reform law instead of approaching it piece-by-piece?
MARY AGNES CAREY: The thing that Republicans in both chambers know, that a repeal effort doesn’t have enough votes to pass, and even if it did, it would be vetoed by the president. But there’s just as much political power, many Republicans believe, in looking at individual provisions of the health law like the Independent Payment Advisory Board or the individual mandate on coverage and exposing them, if you will, looking at them, talking a lot about them to the public during the election season. They feel that has just as much merit as trying to push again for the repeal of the entire measure.
JACKIE JUDD: And when do House Republicans hope to bring the IPAB measure – repeal – to the floor?
MARY AGNES CAREY: The Energy and Commerce Committee passed it this morning, the full Ways and Means Committee is going to mark it up on Thursday. The thought is that this may come to the House floor by the end of the month.
JACKIE JUDD: And presuming it would pass in the House, would it be dead on arrival in the Senate?
MARY AGNES CAREY: That’s the way it looks right now. [Sen.] John Cornyn, a Republican of Texas, has an IPAB repeal bill. He doesn’t have any Democratic co-sponsors. Democrats run the Senate. The thought is that it is dead on arrival. They’ll keep talking about it, but it’s not likely to come for a floor vote in the Senate.
JACKIE JUDD: OK. Thank you so much, Mary Agnes Carey of Kaiser Health News.
This feature was produced by Kaiser Health News with support from The SCAN Foundation.
