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Once dubbed a “death panel”, the Independent Payment Advisory Board is back in the news. The board was devised under the Affordable Care Act as a cost-cutting entity that will materialize once Medicare spending exceeds a specified growth rate.  A Medicare Trustees Report predicts that that trigger point could arrive as early as next month – renewing public outcry about the board’s make-up, lack of oversight and impact on health care access for senior citizens.

How the Independent Payment Advisory Board Works

When Medicare reaches its spending growth threshold, the president will then name appointees to the 15-member Independent Payment Advisory Board.  The board will convene, devise draft recommendations on Medicare cost cutting by September 2017 and submit a formal proposal of those recommendations to Congress in January 2018.

Congressional committees must act by April 2018.  Congress can, with the president’s sign-off, design and approve changes other than those recommended by the board.  But if lawmakers and the president fail to agree, the board’s recommendations go into effect automatically in August 2018.

 Impact on Patients

Some critics argue that the Medicare spending threshold that triggers the Independent Payment Advisory Board is arbitrary.  Others complain that the 15-member board would shoulder little-to-no accountability for its actions. (It does not solicit public input, and the board’s independent designdivorces its power from any accountability to voters.)

But nearly all agree that blunt and potentially ill-advised cuts would hurt Medicare patients.  Reductions in physician reimbursement or hospital payments could lower the number of physicians and facilities that treat Medicare patients.  That, in turn, could mean delayed care, more travel to receive treatment and higher costs for senior citizens.

Legislative Efforts

The board has sparked bipartisan concerns.  The House of Representatives passed legislation in 2015 to repeal the Independent Payment Advisory Board.  Other bills to repeal the board have since been introduced in both the U.S. Senate and House.  To the surprise of many, the board does not appear in the Republicans’ newly proposed Obamacare replacement, the American Health Care Act.

Advocates, patients and health care providers nevertheless remain hopeful that a successful, bipartisan repeal effort can take shape – safeguarding seniors’ access to care before spending growth triggers painful Medicare cuts.

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