Does Obamacare’s Independent Payment Advisory Board (IPAB) Ration Medicare or Create “Death Panels”? - DEBATED


General Reference (not clearly pro or con)
The Patient Protection and Affordable Care Act, Section 1899A, "Independent Medicare Advisory Board," page 371, signed into law on Mar. 23, 2010, available at the Library of Congress website, states:

"(ii) The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."

Mar. 23, 2010 - Patient Protection and Affordable Care Act (HR 3590) (2MB)  



PRO (yes)

Phil Roe, MD, US Representative (R-TN), stated the following in his Dec. 3, 2014 article "Challenging the IPAB," available at his website:

"Perhaps one of the most troubling parts of Obamacare is the Independent Payment Advisory Board (IPAB). The IPAB will consist of fifteen unelected bureaucrats who are granted substantial powers to reduce Medicare spending. IPAB's proposals could, for example, cut reimbursement for specific services that it determines not to be of high value. As a physician, I can tell you first-hand how troubling this mindset can be - every case is unique and must be treated that way...

Supporters of the board like to claim that IPAB is prevented from rationing care, and as far as the language of the law reads, that's true. But dig a little deeper and you find out what's prevented depends on how you define the word 'rationing.' The IPAB is not allowed to say that a person should be denied a particular treatment or type of care, but the IPAB is allowed to cut payments to the physicians that perform these treatments low enough that the effect is no physician is willing to provide the treatment. In my view, the board is rationing care if the effect of their decisions is reduced access to needed care.

Because I am so concerned about the power of this unelected board, I have been an outspoken opponent of the IPAB and have introduced legislation, H.R. 351, to repeal it."




Howard Dean, MD, former Governor of Vermont and former Chairman of the Democratic National Committee, stated the following in his July 28, 2013 article "The Affordable Care Act's Rate-Setting Won't Work," available at wsj.com:

"Clearly, the foremost achievement of President Obama's first term is the Affordable Care Act, and when fully implemented the law will move America closer to universal health coverage—something many progressives have sought for years...

That said, the law still has its flaws, and American lawmakers and citizens have both an opportunity and responsibility to fix them.

One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. 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."




Sarah Palin, former Republican Governor of Alaska, wrote in her June 25, 2012 Facebook post "Death Panel Three Years Later," available online at Facebook:

"Though I was called a liar [in 2009] for calling it like it is, many of these accusers finally saw that Obamacare did in fact create a panel of faceless bureaucrats who have the power to make life and death decisions about health care funding. It's called the Independent Payment Advisory Board (IPAB), and its purpose all along has been to 'keep costs down' by actually denying care via price controls and typically inefficient bureaucracy. This subjective rationing of care is what I was writing about in that first post [on Aug. 7, 2009]:

'The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil.'"




Steven Ertelt, Founder and Editor of LifeNews.com, wrote in his July 31, 2012 article "Obamacare Rationing Begins, States Cut Prescription Drug Benefits," available online at the LifeNews website:

"[Under Obamacare] the department of Health and Human Services (HHS) will be empowered to impose so-called 'quality and efficiency' measures on health care providers, based on recommendations by the Independent Payment Advisory Board, which is directed to force private health care spending below the rate of medical inflation. In many cases treatment that a doctor and patient deem needed or advisable to save that patient's life or preserve or improve the patient's health but which runs afoul of the imposed standards will be denied, even if the patient wants to pay for it.

The law empowers HHS to prevent older Americans from making up with their own funds for the $555 billion the law cuts from Medicare by refusing to permit senior citizens the choice of private-fee-for-service plans whose premiums are sufficient to provide unrationed care but which HHS, in its unlimited discretion, disallows. The Obama health care law could thus lead to elimination of the only way that seniors will have to escape rationing — by limiting their right to spend their own money to save their own lives."




Wesley J. Smith, Senior Fellow in Human Rights and Bioethics at the Discovery Institute, wrote in his July 6, 2012 article "IPAB: the Part of Obamacare That Can't be Repealed," available online at the Daily Caller website:

"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."




CON (no)

Michael Hiltzik, MSc, Pulitzer Prize-winning Los Angeles Times Columnist, stated the following in his Jan. 9, 2015 article, "Here's the Anti-Obamacare Lawsuit That Just Might Deserve to Win," available at latimes.com:

"IPAB is one of the few provisions of the Affordable Care Act that takes direct aim at healthcare costs. But it's a strange creature that has at once too much and too little power. The 15-member board, appointed by the president with Senate approval, swings into action whenever the annual increase in Medicare costs exceeds a certain threshold tied to economic growth.

When that happens, the board is empowered to make recommendations to bring costs back into line. But its proposals can't involve rationing healthcare, increasing Medicare premiums or co-pays, cutting benefits, or restricting eligibility. As a result, IPAB must find savings in the payment and delivery of healthcare services - that is, in payments to doctors and hospitals - rather than loading costs on patients."




Peter R. Orszag, PhD, Chairman of the Financial Strategy & Solutions Group at Citigroup, and former Director of the US Office of Management and Budget, stated the following in his July 31, 2013 article "The Critics Are Wrong about IPAB," available at The Healthcare Blog website:

"The point of having such a board — and here I can perhaps speak with some authority, as I was present at the creation — is to create a process for tweaking our evolving payment system in response to incoming data and experience, a process that is more facile and dynamic than turning to Congress for legislation...

With that in mind, consider the recent attack on the Independent Payment Advisory Board in the Wall Street Journal by Howard Dean, the former chairman of the Democratic National Committee. His critique begins by claiming that the board 'is essentially a health-care rationing body,' even though the legislation specifically states that the board is not allowed to make any recommendations that would ration care."




Glenn Kessler, Washington Post reporter, wrote in his June 27, 2012 column, "The Fact Checker, the Truth Beyond the Rhetoric," in an article titled "Sarah Palin, 'Death Panels' and 'Obamacare,'" available at the Washington Post website:

"It is important to note that the IPAB is primarily charged with helping to reduce the rate of growth in Medicare spending — a goal that both parties say they want to achieve. The IPAB, made up of 15 experts subject to Senate confirmation, would also make broader recommendations about controlling health costs.

Beginning in 2018, if the targets are not met, the board will submit a plan to the White House and Congress to achieve the necessary cuts. Congress could pass a different set of cuts or reject the IPAB recommendations with a three-fifths vote in the Senate.

The health-care law, by the way, explicitly says that the recommendations cannot lead to rationing of health care."




Ira Byock, MD, Director of Palliative Care at Dartmouth-Hitchcock Medical Center, wrote in his July 18, 2012 article "Rational Healthcare, Not Rationing," available at the Los Angeles Times website:

"Many of the people I care for are incurably ill and need expensive medical care to stay alive. They've heard politicians say 'Obamacare' will take away their choices, rob them of hope for living longer and cast their fate to 'death panels' of faceless bureaucrats. Fortunately, none of this is true...

The Affordable Care Act advances a new approach, called accountable care, that aligns financial incentives with high-quality treatment. This key feature of the law transforms healthcare by making local health systems — made up of doctors, hospitals, clinics, laboratories and imaging facilities — responsible for the outcomes of care and the costs for the population of people they predominantly serve...

Reforming healthcare to make it rational is not the same thing as rationing. The best care gives people every chance of living longer and well."




The Kaiser Family Foundation stated in a July 7, 2010 article "Kaiser Health Tracking Poll - July 2010," available at www.kff.org:

"[L]arge shares of seniors mistakenly believe the law includes provisions that cut some previously universal Medicare benefits and creates 'death panels.' Half of seniors (50%) say the law will cut benefits that were previously provided to all people on Medicare, and more than a third (36%) incorrectly believe the law will 'allow a government panel to make decisions about end-of-life care for people on Medicare.'"




Aaron E. Carroll, MD, MS, Associate Professor and Vice Chairman of Health Policy and Outcomes Research in the Department of Pediatrics at the Indiana University School of Medicine, wrote in his July 19, 2012 article "Take Another Look at Health Care Act," available at www.cnn.com:

"Surely you've heard about the Independent Payment Advisory Board? This one, too, has cost the administration politically. It's been demonized as an actual 'death panel' of unelected, unaccountable people who will ration your Medicare. That's not true. The panel is made up of people who need Senate approval (not easy), and they don't serve for life. Moreover, they have a very specific, limited task."




Steve Benen, MA, Producer of The Rachel Maddow Show, stated the following in a Sep. 24, 2012 article "Ryan Doesn't Call Them 'Death Panels' But...," available at the MaddowBlog website:

"In terms of rhetoric, when Ryan says he's not comfortable with the words 'death panel,' I'm glad, but it's worth remembering that this isn't about semantics; it's about policy. Those who talk about 'death panels' aren't just using the wrong language, they're getting the substance wrong, too...

As we discussed in June, the Obama administration seeks to solve this problem [rising medical costs] through IPAB - putting the difficult decisions in the hands of qualified medical and health care professionals, free of the political process on Capitol Hill. And why is this necessary? In large part because Congress has failed so spectacularly in its ability to make these choices on its own...

Besides, it's not like the 15 panelists serving on IPAB have some kind of dictatorial rule over Medicare coverage - the law not only gives Congress oversight authority over the panel, but it also empowers Congress to replace savings if lawmakers disapprove of what the board comes up with."