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Rationing by Any Other Name

November 18, 2014

Just over a week ago, the House Energy and Commerce Committee approved legislation to repeal the Independent Payment Advisory Board (“IPAB”), and did so in an overwhelmingly bi-partisan fashion. This should come as no surprise because IPAB had bi-partisan opposition before it was enacted as part of the President’s healthcare law in March 2010, and opposition to it has only grown since then. The full House will vote on the measure on Thursday.

IPAB represents the worst of the President’s health care law and has been at the forefront of the Goldwater Institute’s lawsuit challenging the Act. IPAB will be composed of 15 presidentially-appointed, unelected bureaucrats who will have sweeping powers; their decisions cannot be reversed by the courts, and are subject to no meaningful Congressional oversight.

Because IPAB is not required to be bi-partisan, President Obama could use his power to make recess appointments, as he has done before. That means he could stack the board entirely with members of his own party, who could then exercise all of the board’s powers. Even worse, while the board is meant to have 15 members, there’s no requirement that it must. The President could give all of this power to just one person by appointing only one board member, or appoint none, in which case his Secretary of Health and Human Services would exercise the power.

IPAB will have the power to dictate whether and how much medical providers can be reimbursed for medical care provided to seniors, which means it can decide not to reimburse for services in any manner it sees fit. That is why IPAB is a rationing board. And despite the law’s prohibition on rationing, that term is not actually defined in the law. “Rationing” will be whatever IPAB says it will be, with no judicial check on its decision.

IPAB is independent all right, but in the worst sense of the word. It is independent of Congress, independent of the judiciary, and independent of the will of the people. Far from representing reform, IPAB will reduce access to and the quality of care for millions of Americans. Call your Representatives and ask them to vote for H.R. 5, the IPAB repeal bill. It is time for Congress to step up and rein in this literally uncontrollable board.

Learn more:

House of Representatives’ switchboard: (202) 224-3121

Goldwater Institute: Coons v. Geithner



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