Posts Tagged ‘IPAB’
March 30th, 2015 at 7:23 pm
Supreme Court Declines Challenge to ObamaCare’s IPAB

The Obama administration got a rare piece of good news today when the U.S. Supreme Court declined to overturn a Ninth Circuit Court of Appeals decision upholding part of ObamaCare.

The case, Coons v. Lew, is an Arizona-based challenge to the Independent Payment Advisory Board (IPAB), the 15-member group of experts empowered to reduce Medicare spending below a certain threshold.

In declining the plaintiffs’ appeal, the Supremes did not in any way indicate that this case is without merit. Rather, it may have been filed too early. Courts are typically loathe to strike down parts of laws that have yet to go into effect. IPAB won’t be making any decisions until 2019 at the earliest.

As usual, the issue is whether IPAB is constitutional. “Its decisions cannot be overridden by Congress without a super-majority and cannot be challenged in court,” explains a report in Politico. If that sounds like near monarchial power for an unelected bunch of experts, well, this is the Obama administration after all.

For now, IPAB is a dormant legal issue. Time will tell if it becomes a political rallying cry in next year’s presidential election.

August 21st, 2014 at 1:23 pm
Ninth Circuit: IPAB Challenge Must Wait

Uncharacteristically, a three judge panel on the Ninth Circuit Court of Appeals has given constitutional conservatives a reason to smile.

The Ninth Circuit, a bastion of liberalism that gets routinely reversed by the Supreme Court, ruled that a constitutional challenge to the Independent Payment Advisory Board (IPAB) is not yet “ripe” for judicial review. Ripeness is the term judges use to denote when a case has a live issue that a court of law can decide. In the IPAB case, the agency hasn’t yet been created, so any challenges to the harm it might do must wait until they actually occur.

And make no mistake, there is much to fear from a fully functioning IPAB. For example, “IPAB is not dependent upon annual appropriations from Congress, need not follow traditional administrative processes, and is not subject to judicial review. As if that were not enough,” writes Jonathan Adler, “[ObamaCare] provides that Congress may dissolve IPAB only if it follows a specified procedure during a seven-month period in 2017 – a statutory provision even the Obama administration has acknowledged could not hold up in court.”

Each of the characteristics of IPAB cited by Adler above are intentionally designed to separate the agency from legislative, judicial and ultimately public control. This is dangerous because “IPAB is authorized to develop self-executing recommendations for limits on Medicare reimbursement rates and other cost controls should the rate of Medicare spending growth exceed a specified target.” That is, IPAB is empowered to ration care for Medicare beneficiaries without any oversight. If allowed to go into effect, IPAB could very well be the biggest step toward a European-style, centrally controlled nationalized health system.

So, how is a loss today really a win for the future? By dismissing the current challenge to IPAB for lack of ripeness, the Ninth Circuit panel is allowing those opposed to the agency to fight another day. At the trial level where this case began, the district judge was not so kind. He ruled against the challengers on the merits, foreclosing future attacks when IPAB actually gets going.

By allowing the challengers to refile later, the Ninth Circuit – at least for the time being – is leaving the door open to another, perhaps more successful assertion of constitutional principle.

July 30th, 2013 at 3:57 pm
Howard Dean: ‘Repeal IPAB’

IPAB – aka, the Independent Payment Advisory Board – is one of the chief cost-containing elements of ObamaCare. As designed, a presidentially appointed panel of medical experts will convene to decide how much the government will pay for certain kinds of care, and who gets which treatments.

That means that “The IPAB is essentially a health-care rationing body,” writes Howard Dean in the Wall Street Journal. “By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.”

Dean, who is a licensed medical doctor and spent 11 years as the Democratic Governor of Vermont before running for president in 2004, knows from experience that IPAB is doomed to fail.

“There does have to be control of costs in our health-care system. However, rate setting – the essential mechanism of the IPAB – has a 40-year track record of failure,” says Dean. “What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.”

Dean goes on to call for a bipartisan repeal of IPAB, which is great to read and should be acted on. But the logic of including IPAB with ObamaCare’s structure makes perfect sense. Government-controlled health care is centrally-controlled and -planned health care.

If Dr. Dean wants a more patient-centered health care system he should be calling for repeal of ObamaCare in its entirety and greater deregulation of the health care industry. Empowering a new generation of medical entrepreneurs that can leverage advances in technology into boutique health care outlets would drive down costs, increase business opportunities and improve the quality of individualized care.

Dean is right to shudder at the care-killing cost of bureaucracy. Maybe one day he’ll discover the possibilities of a freer health care market too.

August 8th, 2012 at 7:32 pm
President’s ObamaCare Deception

Politico reports that in a campaign speech in Colorado today President Barack Obama framed his Patient Protection and Affordable Care Act (aka ObamaCare) this way:

“Let me tell you something, Denver, I don’t think your boss should get to control the health care that you get,” Obama told the crowd at a campaign stop in Colorado. “I don’t think insurance companies should control the care that you get. I don’t think politicians should control the care that you get. I think there’s one person to make these decisions on health care and that is you.”

What the President neglected to mention is that instead of employers, insurance companies, and politicians – and despite his comments about individuals – the constituency he really favors making health care decisions is the federal bureaucracy.

ObamaCare’s Medicaid expansion is intended to capture millions of Americans newly eligible for government coverage that will be – at least initially – cheaper than their current private provider.  The state-based, but federally-directed, health care exchanges are really just Trojan horse structures allowing HHS to seize control of the states’ traditional role in regulating health insurance whenever a state defies a federal prerogative.

And let’s not forget that the Independent Payment Advisory Board is empowered to act as a backdoor ration board, setting price caps on medical reimbursements that will distort the market and cause shortages.  In socialized systems like Britain and Canada long waiting times are the norm, as are denials of procedures in favor of pain management.

All of these elements – Medicaid expansion, federally managed health exchanges, and IPAB – empower one group: unelected, unaccountable bureaucrats.  To claim as the President does that private individuals will be the ones calling the shots on health care decisions is either foolish or deceptive, and I don’t think the man is lacking in smarts.

July 7th, 2012 at 4:21 pm
IPAB Should Be Next ObamaCare Target

Wesley J. Smith reminds us why with ObamaCare’s individual mandate safe for now, conservative litigators should focus on striking down the Independent Payment Advisory Board, the unelected, unaccountable group of “experts” charged with controlling costs under ObamaCare.

There’s not much time left:

According to the terms of the Affordable Care Act, IPAB must submit its first draft recommendations to the health and human services secretary by September 1, 2013. Its first Medicare cost-cutting goals must become law by August 15, 2014.

Why did I write “must” become law” instead of “may”? IPAB’s unique “fast track” authority divests Congress of discretion regarding the amount of money to be cut from Medicare once IPAB has submitted its “advice.” Get a load of these legislative handcuffs:

  • By January 15, 2014, IPAB must submit a proposal to Congress and the president for reaching Medicare savings targets in the coming year.
  • The majority leaders in the House and Senate must introduce bills incorporating the board’s proposal the day they receive it.
  • Congress cannot “consider any bill, resolution, amendment, or conference report … that would repeal or otherwise change the recommendations of the board” if such changes fail to meet the board’s budgetary target.
  • By April 1, all legislative committees must complete their evaluation. Any committee that fails to meet the deadline is barred from further consideration of the bill.
  • If Congress does not pass the proposal or a substitute plan meeting the IPAB’s financial target before August 15, or if the president vetoes the proposal passed by Congress, the original Independent Payment Advisory Board recommendations automatically take effect.

Not only that, but Congress cannot consider any bill or amendment that would repeal or change this fast-track congressional consideration process without a three-fifths vote in the Senate. And to put the icing on the autocratic cake, implementation of the board’s policy is exempted from administrative or judicial review.

Unlike the rest of ObamaCare, IPAB cannot be repealed easily because its enabling statute “entrenches” it from being altered by later Congresses.  Thus, banking on a President Romney and a Republican Congress to get rid of it won’t work.

I’ve written before about the federal case in Arizona challenging IPAB.  It was on hold awaiting the Supreme Court’s decision on the individual mandate.  With the mandate redefined as a tax, the IPAB litigation will proceed, perhaps with a Supreme Court hearing as early as spring 2013.

Keep an eye on this one.  It’s easy to see how an unaccountable board of bureaucrats empowered to control costs could morph into a health care rationing board.

March 23rd, 2012 at 12:16 pm
House Republicans Vote to Repeal IPAB

With the Supreme Court getting ready to hear arguments about the (un)constitutionality of ObamaCare, House Republicans yesterday voted to repeal the Independent Payment Advisory Board (IPAB), one of ObamaCare’s provisions that may be left unaffected by the Court’s decision.

As the Washington Times reports, this is “the 26th time the House has voted to partially or completely repeal the sweeping overhaul” of the health care industry.

Like the other 25 times, this House vote won’t be seconded by the Democratic controlled Senate.  But in an election year that’s hardly the point.  What matters right now is that House Republicans continue to highlight how elements like IPAB destroy freedom and choice in health care by letting 15 unelected bureaucrats instead of the free market decide the price of services.

On to number 27!

March 1st, 2012 at 11:33 am
Absolutely Right on IPAB

Ashton is right on target on the Independent Payment Advisory Board, and the Goldwater Institute deserves a lot of credit for challenging it. I think the challenge has a great deal of merit. I wrote on it here.

April 25th, 2011 at 1:01 am
More on “Who Decides?”

In my last post, I explained that Obamacare’s Independent Payment Advisory Board (IPAB) would cut far more Medicare services, without giving patients any real choice in the matter, than Rep. Paul Ryan’s budget proposal would ever do — and that Ryan’s would give patients control, whereas IPAB would leave them at the mercy of bureaucrats far removed from the scene. Again, the issue is, who decides?

That’s the theme in areas other than IPAB, too. Indeed, it is the central question of Obamacare. Obama’s system and its corollaries leave all authority in the hands of central planners — disembodied persons, as far as the patient is concerned, for whom the patients are little more than statistics on a spread sheet.

Fox news contributor and former Reagan-Bush in-house thinker James Pinkerton is rightly banging the drum for more options for patients and providers alike. In what he calls a “Serious Medicine Strategy,” Pinkerton explains that the best way to keep costs down is to encourage the development of cures rather than of merely managed treatments. As Pinkerton says, healthy people are less expensive than sick people. Therefore, intellectual property rights for researchers should be protected better, or longer, than they are now. The FDA should be more lenient, or more rapid, in approving medicines — at least for trial use, with appropriate warnings, perhaps. And so on. The idea is to provide more chances for more cures, and more choices for everybody involved — mostly through the free market.

There is a lot more to say on this and related topics. Again, though, the central message is this: Where bureaucrats and central planners exert too much control, or interfere too much, the ultimate provision of services is likely to be either worse, or more expensive, or both. But if people are freed to pursue their own best interests. They will. More on this as the weeks go by.

April 21st, 2011 at 11:03 am
On Death Panel, Who Decides?

Who decides? That is the most important question when it comes to Medicare savings. First, some background:

Conservatives suddenly are abuzz again with talk of an Obamacare “death panel,” and in substance they have a point: If the Independent Payment Advisory Board (IPAB) works anything like its model in Oregon… and if government health-care programs effectively crowd out private options so that the bureaucratic decision-makers in the government program are, for all intents and purposes, the ultimate arbiters of who receives which treatments… then people have serious reason to worry that their lives could be foreshortened by government fiat. Employing the phrase “death panel” has its advantages and disadvantages (the biggest of the latter is that it keeps the establishment media from giving the complaint any credence, even though the problems with IPAB are both real and acute), but the board’s potential for harm is evident in the fact that 72 Democratic House members last year joined Republicans in asking for the panel to be removed from the bill.

Meanwhile, the anti-Obamacare lawsuit which takes on IPAB directly (among other things), led by the Goldwater Institue, seems to me absolutely on target in challenging how the board is set up to be a power unto itself with no congressional oversight of any relevance or weight. That suit merits far more attention, via full columns rather than quick blog mentions, and conservatives are foolish not to rally in support of it.

With all the anti-IPAB talk bubbling up right now, though, the talk has been strangely disconnected from the budget debate that has been front and center of the American political universe for weeks. Yet with President “Don’t Interrupt Me” Obama jetting all over the country to spread demagogic scare tactics against the Medicare portion of Rep. Paul Ryan’s budget proposal, those on the right really haven’t done much to parry the specifics of his attacks on the “voucherization” or “privatization” of Medicare. Yet the fact is that the president aims to save almost as much money from Medicare as Ryan does — except that he wants to use IPAB to do it.

That’s why conservatives should take up his challenge. We should answer that it is he, not we, who is (/are) for “cutting” Medicare. He does it by giving vast powers to unelected bureaucrats almost entirely unanswerable to Congress. We achieve savings, which may not involve actual cuts in care at all, by giving power to the patients themselves. Conservatives should do a very specific poll on Medicare Part D. If, as I suspect, it is still a highly successful program, then conservatives should say that all Ryan wants to do is to make all of Medicare work the same way that Part D does — except without the doughnut hole. The idea is to allow seniors themselves to achieve savings while finding the best care they can.

We save; Obama cuts. More importantly, we give the power to the patients; he gives it to bureaucrats with a mandate to chop costs by unaccountable orders.

So the question is, Who decides: The individual patient, or the government commissars?

When phrased like that, conservatives don’t even need to say the phrase “death panel.” For most listeners, the scary implications of Obama’s approach will be clear.