House IPAB Hearings-II

Two House Committees will hold hearings today on IPAB. There is a great deal of hypocrisy in the Republican criticism of IPAB, especially that levied by Rep. Paul Ryan, because he co-sponsored legislation in the 111th Congress (The Patients’ Choice Act) that proposed two boards comprised of what he know calls ‘unelected bureaucrats.’ I posted on this last night.

A second line of criticism levied against the IPAB is the tried and true charge of rationing. This criticism is also hypocritical. My reading of the Patients’ Choice Act, Co-sponsored by Rep. Ryan in May, 2009, shows that the two boards he would have created have more power to ‘ration’ and control the practice of medicine than does the IPAB. Don’t take my word for it, read the relevant section of the bill (pages 205-216). You will hear plenty on IPAB at the hearings…as you do, keep the following in mind.

The 15 member board (Forum for Quality and Effectiveness in Health Care) proposed by Rep. Ryan would:

  • Have the goal of promoting transparency in price, quality, appropriateness, and effectiveness of health care (sec. 813, p. 211-12)
  • Will create guidelines to reach this goal (sec. 813, p. 212)
  • Guidelines must follow standards of research and the best evidence and present findings in an understandable format ( sec 813, p. 212)
  • To develop guidelines, the Director of the Commission can contract with outside, private entities to complete research (sec 813, p. 212)
  • The Board was directed to produce their first guidelines by January 1, 2012
  • The Board was to bring forth recommendations each year, and not only when certain cost inflation targets were not met as with IPAB (sec 814, p. 213-14)
  • The Board has more teeth than the IPAB. Here I will simply reproduce the text of the Patients’ Choice Act, sec. 814(a)(b)(1)-(2) p. (214):

(b) ENFORCEMENT AUTHORITY.—The Commissioners, in consultation with the Secretary of Health and Human Services, have the authority to make recommendations to the Secretary to enforce compliance of health care providers with the guidelines, standards, performance measures, and review criteria adopted under subsection(a). Such recommendations may include the following, with respect to a health care provider who is not in compliance with such guidelines, standards, measures, and criteria: (1) Exclusion from participation in Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C.1320a–7b(f))).(2) Imposition of a civil money penalty on such provider. [emphasis mine]

When you listen to the hearings today, think of these facts. Especially in the case of Rep. Ryan, who has put himself forward as a truth teller who is helping our nation address our fiscal woes. He needs to explain how he could propose the use of unelected boards to promulgate guidelines, and grant them the authority to ban providers who don’t follow such guidelines from participating in Medicare and Medicaid and/or impose a civil penalty, and then say what he has said about the IPAB.

It is possible to change ones mind. Rep. Ryan and others may have thoughtful reasons for changing their mind, but they have so far offered no thoughtful discourse on IPAB. And if you do change your mind with a track record like that noted above, I would expect you to say something like “I used to support boards similar in concept to IPAB, that actually had more power to shape the health care system than does IPAB. I no longer do so because”….

Maybe the hearings today will fill in the blank.

About Don Taylor
Associate Professor of Public Policy at Duke University and author of Balancing the Budget is a Progressive Priority. On twitter @donaldhtaylorjr

3 Responses to House IPAB Hearings-II

  1. Andrew says:

    Interesting post and I’m looking forward to seeing what the hearings will be like today.

    I agree that the two are eerily similar. I’m not sure I agree that Ryan’s board would have had more teeth compared to IPAB. From my reading of the quote, it seems like Ryan’s board would make recommendations only, but that the recommendations could potentially be devastating for providers (referencing your bolded items). The IPAB’s recommendations, in contrast, MUST be implemented (or overridden by Congress or the Secretary).

    In thinking about which board would have more of an impact on Medicare year in and year out, I think IPAB wins handily.

  2. steve says:

    Pretty amazing how many GOP ideas were incorporated into the ACA, and vice versa. Makes all of those claims about it being pure socialism kind of silly.

    Steve

  3. Don Taylor says:

    @Andrew
    good points. The text of PCA was not marked and didn’t go through hearings so is quite general and does include the word ‘may’ (line 9 p. 214) whereas IPAB recs are triggered automatically if health care inflation targets aren’t met. I follow your point that IPAB likely to have more consistent relatively small effects (cut pay rates) whereas the top penalty noted in PCA is quite a big penalty. I don’t claim there no differences between the approaches. However, the rhetoric used against IPAB is absurd and overstated given what I laid out in the post.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 157 other followers

%d bloggers like this: