House Repeals IPAB; Bill's Future Doubtful

In what appears to be a futile gesture, the U.S. House of Representatives passed legislation abolishing the Independent Payment Advisory Board (IPAB), a 15-member panel appointed by the president that would recommend cuts in Medicare payment fees to physicians if federal spending on health care reaches certain levels.

The House passed HR 5, the Preserving Access to Healthcare Act, by a vote of 223 to 181. However, news reports say it is unlikely Senate Majority Leader Harry Reid will ever call the bill to the Senate floor for a vote. And even if he did and it passed, the reports say, President Obama would veto it.

U.S. Rep. Michael C. Burgess, MD (R-Texas), vice chair of the House Energy and Commerce Committee's Subcommittee on Health and chair of the Congressional Health Care Caucus, urged the Senate to pass the bill . He said the IPAB "encompasses all that is wrong with the Affordable Care Act," which he said will disrupt the practice of medicine.

"Along with many excesses and constrictions in the law, IPAB represents the worst of what is envisioned under the health care law," he said . "As a physician, as a member of Congress, and as a patient in my 60s, I am offended by the Independent Payment Advisory Board . IPAB is not accountable to any constituency, and only exists to cut provider payments to fit a mathematically created 'target.'

He added that IPAB "would have far-reaching implications beyond Medicare for all of our nation's doctors. IPAB throws the government into the middle of the sacred doctor-patient relationship with the power to influence prices, reimbursements, and access. Beyond controlling Medicare, IPAB's rationing edicts would serve as the benchmark for private insurance carriers' own payment changes. Because of limitations on what the control board can cut, the majority of spending reductions would come from cuts to Part B and Part D provider fees."

The American Medical Association said the bill the House passed combines two legislative proposals – the Medicare Decisions Accountability Act (HR 452) and the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act (HR 5).

HR 452 was combined in the Rules Committee with the HEALTH Act, which provided savings that are more than sufficient to offset the estimated $3.1 billion cost of repealing IPAB. The HEALTH Act contains medical liability reforms, including a $250,000 cap on noneconomic damages. The version of the HEALTH Act that was included in the combined bill did not include provisions that would permit the introduction of evidence of income from collateral sources at trial, reflecting modifications made by the House Judiciary Committee, AMA said.

AMA said the House approved several additional amendments during the debate over HR 5. They would:

  • Restore the application of antitrust laws to health insurance by amending the McCarran-Ferguson Act;
  • Address the crisis in access to emergency care by extending liability coverage to on-call and emergency physicians under the Federal Tort Claims Act; and
  • Grant limited civil liability protection to health care professionals who volunteer at federally declared disaster sites.

Action, April 3, 2012


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