SUMMARY: The board, also known as the IPAB, was created to limit the growth of Medicare costs. The 2010 Patient Protection and Affordable Care Act explicitly prohibits the IPAB from making “any recommendation to ration health care,” raise premiums, increase deductibles or copayments or modify the criteria to be eligible for Medicare.
So right off the bat, Rogers' assertion is wrong.
Under the law, the IPAB would recommend cost-cutting measures only in years when Medicare costs rise beyond a pre-set target level. The board’s recommendations would take effect only if Congress fails to come up with an alternate solution.
ANALYSIS: Rogers’ opinion piece, titled “Healthcare law’s costly spike,” criticizes several provisions in the Patient Protection and Affordable Care Act, also known as federal health care reform, or Obamacare.
Rogers noted that he opposes the health care law’s creation of IPAB, a board that, in his words, would “ration Medicare benefits.”
“It’s bad policy,” Rogers wrote. “Seniors need to be more in control of their Medicare coverage and benefits, not less.”
An Anniston Star reader requested that the newspaper fact-check that claim — and that reader’s instinct seems to have been on the money.
Section 3403 of the health care law creates an Independent Medicare Advisory Board. (The name was later changed to Independent Payment Advisory Board, or IPAB.) The law expressly prohibits the board from making “any recommendation to ration health care, raise revenues or Medicare beneficiary premiums … increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments), or otherwise restrict benefits or modify eligibility criteria.” So rationing is explicitly forbidden in the law.
Rogers’ spokeswoman, Shea Snider, said the congressman’s statement on rationing was a matter of opinion.
“Congressman Rogers’ comment ‘what I consider’ expresses an opinion based on facts,” she wrote in an email to The Star.
“Rationing” is, to a certain extent, in the eye of the beholder. One could argue that doctors ration health care by treating only the sick. Liberal commentators often note that the current system rations health care based on ability to pay. And in recent months, a number of Republican candidates have attempted to persuade people the IPAB is a rationing board with unchecked power to determine who gets treated, and for what.
But the health care law is pretty specific about what cost-cutting measures the IPAB can propose. Changes to copayments and other restrictions to benefits are off limits, according to the wording of the law. The board can propose other cost-saving measures including promotion of wellness and prevention programs, and cuts to Medicare’s payments to medical service providers.
That last power — the ability to cut payments to doctors and managed care organizations — could affect the availability of care if the cuts are steep, said Timothy Jost, a law professor at Washington and Lee University who wrote an article on the IPAB for the New England Journal of Medicine.
“There is a concern that if you cut those payments too much, providers will drop out of the system,” Jost said. But Jost said the Independent Payment Advisory Board won’t be able to make any decisions about specific treatments and who gets them.
“It’s not a death panel,” Jost said. “They’re not going to decide that Grandma doesn’t get her heart surgery. They just don’t have that kind of power.”
According to the law, the IPAB can suggest cuts only when Medicare costs are projected to rise higher than a pre-set rate. And the board’s cuts will take effect only if Congress fails to agree on alternatives that would trim Medicare cost increases by the same amount.
“All they can do is make recommendations, which go into effect if Congress fails to act,” Jost said. “But then, Congress will probably argue with itself until the deadline passes.”
That’s essentially what has happened with the IPAB’s predecessor, the Medicare Payment Advisory Commission. A Republican-controlled Congress created MedPAC in the 1990s as an advisory body to limit Medicare costs. Jost said Congress has usually ignored MedPAC’s recommendations.
According to the Associated Press, the House already voted last month to eliminate the IPAB, in a vote largely along party lines. The Democratic-controlled Senate is expected to reject the repeal and keep the IPAB intact.
