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September 8, 2017

While Washington is at loggerheads over reforming health care, there’s one nefarious provision in the Affordable Care Act (ACA) that’s about to kick in high gear – the Independent Patient Advisory Board (IPAB). And it’s time for Congress to take action and stop it.

Lawmakers on both sides of the political aisle have grown increasingly concerned over the IPAB, an unelected, unaccountable board empowered to make decisions about healthcare not on the basis of a patient’s needs, but on bureaucratic spending limits and one-size-fits all political decrees. Their concern is not only well-founded, but they also are probably not nearly as concerned as they should be. As we previously pointed out, lawmakers underestimate the Board’s power, erroneously assuming that the single cost-cutting tool at the Board’s disposal is reducing Medicare payments to health care providers. But the Affordable Care Act requires the Board to consider the effect of the private sector on health care costs and empowers the Board to govern both government and private health care so long as the Board says those decisions are “related to the Medicare program.”

But reducing Medicare payments is far from the only cost-cutting item on IPAB’s menu.

ACA architects claim that the law prevents the Board from rationing health care—the granddaddy of all cost-cutting measures. But what constitutes rationing? Since that term is undefined in the law, interpretation and discretion are left to the Board. What’s more, IPAB is immune from judicial review, so patients and doctors can’t turn to the courts for protection if the Board prevents them from receiving or delivering care.”

The IPAB is established when the five-year average per-capita growth rate for Medicare spending exceeds its annual target. Last year’s annual Medicare Trustees report had predicted that the IPAB would be triggered this year. It came as a surprise to many that this year’s report, which was released last week, did not trigger the IPAB.

But the fact that IPAB was not triggered should not bring a sigh of relief. That is because the clock is ticking on one of the last remaining options for eliminating this board. Lawmakers have until August 15 to pass joint resolutions in both chambers and obtain the president’s signature.

There are legislative vehicles in both chambers of Congress to do just that. Sen. John Cornyn and Rep. Phil Roe are both sponsoring legislation in their respective chambers, with the House legislation enjoying co-sponsors from both sides of the political aisle. If passed and signed by the president, IPAB dissolution would provide a much-needed IPAB escape hatch.
The Board may be the single-biggest threat to health freedom in the U.S. seems to elude many of the same people who have the authority – and obligation – to stop it.

Many Congressional lawmakers seem desperate to “do something” about the ACA. Dissolving the Board, whose unchecked and irrevocable power should be a top priority for lawmakers on both sides of the aisle, would be a great place to start.

Naomi Lopez Bauman is the director of healthcare policy, and Christina Sandefur is the executive vice president of the Goldwater Institute. Ms. Sandefur is also lead counsel in Coons v. Lew, the only federal legal challenge of the IPAB.



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