UPDATE: IPAB Repeal Passes the House

The House voted to repeal the Affordable Care Act's (ACA) Independent Payment Advisory Board (IPAB). H.R. 1190, the Protecting Seniors' Access to Medicare Act of 2015, passed by a vote of 244-154, with 11 Democrats joining House Republicans who unanimously supported the measure.

Created under the ACA, IPAB is comprised of 15 appointed members and tasked with reducing Medicare spending should costs exceed a target growth rate. IPAB will only be formed if Medicare spending exceeds target growth rates, and because of unusually low medical cost inflation in recent years, the board has not yet been activated.

If initiated, IPAB has the ability to force significant cuts to provider reimbursements without ensuring that Medicare beneficiaries receive quality care from skilled providers. Select providers are exempt from the board's purview, and therefore greater pressure will be placed on cutting Medicare reimbursements for those providers that can be hit by IPAB's actions, a group that includes physicians.

Perhaps most troubling, Congress's role in determining Medicare payment policy will be seriously compromised once IPAB is in place. Instead, a board of unelected bureaucrats will have the power to strong arm Congress into accepting spending cuts. This system will seriously undermine the transparency provided by Congress, where bills are presented during public hearings and are subject to public debate. IPAB will not provide for stakeholder input beyond its appointed members, and there is far too little clinical representation within that group.

The $7.1 billion legislation is paid for with money from the Public Health and Prevention Fund, also established by the ACA. This offset was opposed by many Democrats who may have otherwise supported the legislation, including Rep. Linda T. Sánchez (D-Calif.), who introduced the repeal bill with Rep. Phil Roe (R-Tenn.) earlier this year.

The cuts to the prevention fund were added to the original bill through an amendment offered by House Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-Pa.).

The president has already threatened to veto the legislation should it reach his desk.