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Washington Update: Support Repeal of IPAB

The Independent Payment Advisory Board, created by the 2010 Affordable Care Act to control Medicare spending, threatens the ability of Congress to ensure access to needed health care, say SVS advocacy staff and members.

And with the board’s duties likely to be triggered this year, the result could be $1.5 billion in Medicare cuts in 2019, with steeper cuts predicted for 2022 and 2024.

This scenario has prompted SVS Government Relations Committee members to designate repeal of this board the No. 1 issue currently facing SVS in Congress and to urge fellow SVS members to email letters to their members of Congress, asking them to support repeal.
The board is to make recommendations to keep spending under control if spending is projected to exceed the cap. It consists of 15 members appointed solely by the president.

A bipartisan House bill, H.R. 849 ("Protecting Seniors’ Access to Medicare Act of 2017)," sponsored by Rep. David Roe, MD (R-TN) and Rep. Raul Ruiz, MD (D-CA), presently has 125 co-sponsors. Two Senate bills, S. 260/S. 251, sponsored by Sen. John Cornyn (R-TX)/Sen. Ron Wyden (D-OR), have a total of 45 co-sponsors.

Dr. Michael Dalsing, Government Relations Committee chair, said the government has "unrealistic spending targets" on which spending cuts will be based; these cuts take effect automatically unless Congress blocks or amends them. If IPAB members fail to report recommendations, or the board never becomes operational, one person – the secretary of the Department of Health and Human Services (Dr. Tom Price, MD) – will make those decisions, which are not subject to judicial review.

Providers representing approximately 37 percent of all Medicare payments, including hospitals and hospice care, are exempt from IPAB cuts until 2020. "That means initial IPAB cuts will fall disproportionately on other providers, including vascular surgeons," said Dr. Dalsing. "Particularly with the passage of the Medicare Access and CHIP Reauthorization Act, vascular surgeons are committed to improving the value and cost-effectiveness of health care for Medicare beneficiaries. IPAB, however, is not a suitable mechanism for these goals," he said.

A sample letter for members’ use is at vsweb.org/ContactCongress.