House IPAB Hearings

The House will have two hearings (Budget Committee and Commerce Committee) on the Independent Payment Advisory Board (IPAB) July 12 (text of law sec. 3403; and nice overview of IPAB from Kaiser).

I realize that politicians change their position on issues as their political needs and circumstances change, but I have found the degree of animus and rhetoric thrown against the IPAB by Rep. Paul Ryan and many other Republicans* to be shocking because Rep. Ryan (along with Devin Nunes, and Sens. Coburn and Burr) introduced a bill in the last Congress (the Patients’ Choice Act [PCA]) that created two similar boards that actually were to have more power than is granted to IPAB. Here is a comprehensive post I wrote  looking at the IPAB through the lens of what Rep. Ryan previously proposed in terms of unelected boards, including detailed references to Ryan’s PCA with links.

Much of the rhetoric against the IPAB levied by Rep. Ryan (and others) has focused on the narrative that it empowers unelected bureaucrats. The Patients’ Choice Act proposed by Rep. Ryan in the 111th Congress created two boards:

  • Health Services Commission. 5 members appointed by the President and Confirmed by the Senate. The PCA stipulates that these 5 people cannot have another job, but must serve in this role full time. [page 206-210]
  • The Office of the Forum for Quality and Effectiveness in Health Care, a 15 member board appointed by the 5 members of the Commission noted above. [page 210-215]

The IPAB, created in the ACA, creates:

  • 15 member board (IPAB) appointed by the President and confirmed by the Senate, with the 15 members having to serve on a full time basis (cannot have another job). [page 1019-1021]

The Patients’ Choice Act was introduced on May 20, 2009, about 1 month before the first House Committee passed HR3200. The IPAB is an example of an idea initially put forth by Republicans ending up in the ACA. The rhetoric used against IPAB about unelected bureaucrats, especially when made by Rep. Ryan, seems blatantly hypocritical to me given what he and his 3 Republican colleagues had previously co-sponsored in this area. I think Rep. Ryan owes the country an answer as to why he used to be for boards appointed by the President, confirmed by the Senate, and who gave up their job in order to work on important health policy issues for the federal government, while he is now adamantly opposed.

*There are some Democrats opposed to IPAB as well.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to House IPAB Hearings

  1. MV says:

    Why exactly do you find this shocking? Have you not been paying attention? Do you not know the policies of the Republican party?

    • Don Taylor says:

      Naive I guess. Also, Rep Ryan has put himself off as the man of big ideas. Maybe he has a thoughtful reason for changing his mind, but if so you would start your comments on IPAB in this way ‘I used to favor unelected boards and even introduced a bill that had two in the last Congress, however, I have changed my mind because’….

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