Obamacare's Advisory Board Could Be a Real Killer

The Independent Payment Advisory Board will have unprecedented power with little oversight.


A critical part of President Barack Obama’s new healthcare initiative, the Patient Protection and Affordable Care Act—commonly known as Obamacare—is the Independent Payment Advisory Board. 

Composed of members to be appointed by the president without Senate confirmation, IPAB’s explicit purpose is to reduce the rate of growth in Medicare without affecting coverage or quality.

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Under Obamacare, IPAB’s recommendations must be adopted. Congress is denied the power to overrule its decisions, the first of which are due in a report scheduled for release in July 2014.

The way it is supposed to work, say healthcare experts, is that IPAB must develop proposals to reduce per capita Medicare spending if the chief actuary of the Centers for Medicare and Medicaid Services determines that the projected per capita growth rate in Medicare exceeds the target growth rate from one year to the next.

As you can imagine, legislative doublespeak aside, the more people learn about IPAB, the less they like it. So a broad-based coalition of organizations, including healthcare organizations, employers from across the country, healthcare consumers, and patients are asking Congress to take another look at it, suggesting in a letter to Congress that it “will not only severely limit Medicare beneficiaries’ access to care but also increase healthcare costs that are shifted onto the private sector.” [Read more stories about healthcare.]

U.S. Secretary of Health and Human Services Kathleen Sebelius defends the program. 

In a recent op-ed published in Politico, Sebelius dismissed concerns about IPAB, writing, “Critics say it will ration care and put bureaucrats in charge of the health care system. Nothing could be further from the truth.”

Others are not so sure. Georgia Republican Rep. Phil Gingrey, the cochairman of the GOP House Doctors Caucus and a physician himself, went so far as to say that IPAB could lead to rationing, and that, he said, meant patients could die.

“Under this IPAB we described that the Democrats put in Obamacare,” Gingrey said at a recent press conference, “where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you, when you withdraw that, the patient is going to die.”

The nearly 300 organizations that signed the letter to Congress seem to be on Gingrey’s side, more or less. Their letter complains that “IPAB will have unprecedented power with little oversight, even though it has the power to literally change laws previously enacted by Congress. Further, the law specifically prohibits administrative or judicial review of the secretary’s implementation of a recommendation contained in an IPAB proposal.”

An unaccountable body making decisions about patient care that will determine who receives the care that will allow them to live and who will be denied care and allowed to die, all in the name of costs savings. Where have we heard this before?

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