By NRLC Department of Medical Ethics
Thirteen organizations of specialty physicians, grouped as the Alliance of Specialty Medicine, endorsed repeal of the Patient Protection and Affordable Care Act’s Independent Payment Advisory Board (IPAB) in a January 28 letter to members of Congress. The doctor groups endorsed a bi-partisan bill, H.R. 351, to repeal it.
“Significant health care decisions must not be made by a group of unelected, unaccountable individuals with little or no clinical expertise or the oversight required to protect access to care,” the medical groups wrote. “[T]he process and structure of the IPAB is fraught with potential unintended consequences and the IPAB lacks the clinical expertise and the research capacity to examine the national and regional effects of proposed recommendations to ensure patients are not unduly impacted.”
A January 29, 2013 article in The Hill explained, “The IPAB is one of the most controversial pieces of the Affordable Care Act, and it has never been popular with doctors.”
In addition to having authority to limit Medicare reimbursement rates, IPAB also has a key role in suppressing nongovernmental health care spending. IPAB is instructed by the health care law to make recommendations to limit what all Americans are legally allowed to spend for their health care so as to hold it below the rate of medical inflation.
The health care law authorizes the Department of Health and Human Services (HHS) to implement these recommendations by imposing so-called “quality” and “efficiency” measures on health care providers. IPAB, in conjunction with the federal Department of Health and Human Services (HHS), is to achieve this goal by limiting what treatment doctors are allowed to give their patients.
The documentation can be found here: www.nrlc.org/HealthCareRationing/Life at Risk Routes to Rationing 6272012 (1).pdf
What happens to doctors who violate a “quality” standard by prescribing more lifesaving medical treatment than it permits? They will be disqualified from contracting with any of the health insurance plans that individual Americans, under Obamacare, will be mandated to purchase. Few doctors would be able to remain in practice if subjected to that penalty.
This means that treatment a doctor and patient deem advisable to save that patient’s life or preserve or improve the patient’s health — but which exceeds the standard imposed by the government — will be denied even if the patient is willing and able to pay for it.
Although the board is supposed to begin meeting this year, the president has not yet named a single person to serve. There is speculation that the sweeping unpopularity of the IPAB means that there will be a political fight over nominees to the board. Regardless of who is on the board – or whether it ever comes into existence — HHS will have enormous power and leeway to impose measures that might lead to rationing of care.
Even if the House does vote to repeal the IPAB, H.R. 351 would be expected to stall in the Democratically-controlled Senate, or face a veto by President Obama. Nevertheless, support for IPAB repeal may help remind and educate Americans about the dramatic limits on their freedom to spend their own money to save their own lives, and those of their family members, embodied in the new health care law.