Medicare, ACA and the Big, Bad IPAB


Remember the Affordable Care Act’s (ACA) panel charged with holding down Medicare costs, the Independent Payment Advisory Board (IPAB)? House Republicans, the ones with their hair on fire about deficits and runaway Medicare costs — “Not only are they unwilling to propose actual, concrete cost-cutting measures for Medicare,” says Kevin Drum at Mother Jones, but they are determined to keep the IPAB from holding down those runaway costs. Via The Hill:

House Republicans signaled Thursday they will not follow rules in President Obama’s healthcare law that were designed to speed Medicare cuts through Congress.

The House is set to vote Thursday afternoon on rules for the 113th Congress. The rules package says the House won’t comply with fast-track procedures for the Independent Payment Advisory Board (IPAB) — a controversial cost-cutting board Republicans have long resisted.

The rules package signals that Republicans might not bring up Medicare cuts recommended by the IPAB — blocking part of a politically controversial law, and resisting Medicare spending cuts.

Except “cuts” means savings to taxpayers, not cuts to beneficiaries. The IPAB board (Palin’s “death panel”) is prohibited by law from … aw, read it yourself on page 490:

The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria.

The New York Times elaborates [Emphasis mine]:

If the projected growth rate in per capita Medicare spending exceeds specified targets pegged initially to an average of general and medical inflation and later to gross domestic product, the board must recommend changes (most likely cuts in payments to health care providers) to bring the growth rate back in line. Congress can override the board’s recommendations, but it must still find equivalent savings.

But there is no board. Yet. Chris Hayes on Saturday said what none of the disaster capitalists in the Village want to acknowledge: there is no crisis, either. Or at least, because the ACA hasn’t fully kicked in, we won’t know if there still is a health cost problem for another three to four years. But no need to let that get in the way of posturing and Fix the Debt hysterics. Via karoli at Crooks and Liars, here’s what Hayes lays out in the video above:

  1. Medicare is in about the same shape it has been in since its inception. It’s solvent for 11 more years without touching anything. That’s standard solvency now and yesterday for Medicare.
  2. We spent an enormous amount of time and political energy on the Affordable Care Act, which is a 2,000 page bill, as the Tea Party and Republicans are fond of pointing out. The Affordable Care Act has consumer protections and Medicare reforms written into it. The consumer protection piece is about 60 pages. The other 1,940 pages are Medicare reforms intended to control the rising cost of health care.
  3. We will not know whether those reforms are effective for three to four years. What we know today is that Medicare spending has decreased over the last three years, and that’s before all of the ACA reforms take hold.

Holding down costs is, after all, the point of the ACA, and the IPAB that Republicans want to do away with even as they complain that deficits threaten our very way of life. Furthermore, writes Ed Kilgore:

What’s really maddening is that IPAB—following the overall thrust of Obamacare—is designed to secure savings not just for Medicare but for the entire health care system by encouraging better medicine, not reductions in health coverage for seniors. It seems Republicans are only interested in health care cost containment measures or “entitlement reform” if it comes at the expense of beneficiaries.

Yes, because in the wake of the just-ended fiscal cliff faux crisis, Republicans need another ‘Blazing Saddles’ faux hostage-taking to hammer the President with: raising the debt ceiling. And because payments to health care providers are not the costs the GOP wants to contain. As karoli suggests:

You know why it is that conservatives make such a big deal out of the Independent Payment Advisory Board (IPAB)? It has nothing to do with death panels and authoritarianism, despite what they whine about in public. It is because it will quite likely end the medical gravy train so many have been on for so long, without decreasing quality of care.

I repeat: Without decreasing quality of care. It will end practices like charging uninsured patients $3,000 for a colonoscopy that costs $300. It will begin to end unnecessary tests and procedures which are performed because fee-for-service medicine requires more and more services to maintain profitability. This is why conservatives hate it with an undying passion. It actually limits and controls costs.

Limiting costs, as in profits, for “producers.” At least, in theory it limits costs, according to Hayes. Not that Villagers want to wait and see how that ACA experiment plays out in three or four years. After supporting a bank bailout that cost somewhere between $7.7 trillion and $29 trillion, now that we’re talking about money for the little people, they’ve ginned up a serious debt crisis. And they know how to use it.


  1. Alva Slane says:

    The Greens repeatedly say there have been massive cuts to early childhood education. The figures are as follows.