Coalition To Protect Patients' Rights Lies About Health Care Law, Pushes For IPAB Repeal

August 10, 2011 12:31 pm ET

The Coalition to Protect Patients' Rights (CPPR) is out with a new 30-second television ad attacking the Independent Payment Advisory Board (IPAB) created by the Affordable Care Act. The ad begins by taking a quote from then-Speaker Pelosi (D-CA) out of context and moves on to the worn-out lie that the health care law cuts billions from Medicare. CPPR continues with its distortions by falsely claiming that IPAB will deny care to seniors and be "like a Medicare IRS," when the truth is that the law prohibits IPAB from rationing care or increasing taxes. And far from IPAB being "unaccountable," Congress retains the authority to make final decisions on the board's recommendations. Rather than contributing to "more wasteful Washington spending," IPAB's ultimate goal is to reduce Medicare costs, saving the government money, while protecting the quality of care and benefits for seniors.

Coalition to Protect Patients' Rights: "CPPR Repeal IPAB"

[NARRATOR:] Do you remember when they said, [REP. NANCY PELOSI:] "We have to pass the bill so you can, uh, find out what is in it." [NARRATOR:] Well, we found out. And it's bad. After cutting $500 billion from Medicare, the president's health care law created a new board of 15 unelected bureaucrats, unaccountable, like a Medicare IRS with the power to cut payments to doctors and deny seniors care to pay for more wasteful Washington spending. Tell Washington bureaucrats shouldn't have the power to deny seniors care.

CPPR Took Pelosi's Comments Out Of Context

Speaker Pelosi: "You've Heard About The Controversies" But Not The Actual Content Of The Affordable Care Act. In March 2010, Speaker Pelosi said:

You've heard about the controversies within the bill, the process about the bill, one or the other. But I don't know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention-it's about diet, not diabetes. It's going to be very, very exciting.

But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy. Furthermore, we believe that health care reform, again I said at the beginning of my remarks, that we sent the three pillars that the President's economic stabilization and job creation initiatives were education and innovation-innovation begins in the classroom-clean energy and climate, addressing the climate issues in an innovative way to keep us number one and competitive in the world with the new technology, and the third, first among equals I may say, is health care, health insurance reform. Health insurance reform is about jobs. This legislation alone will create 4 million jobs, about 400,000 jobs very soon.

We must have the courage, though, to get the job done. We have the ideas. We have the commitment. We have the dedication. We know the urgency. Now we have to have the courage to get the job done. So proud that President Obama is taking the message so forcefully to the American people! This is long overdue, a hundred years. [Speaker Pelosi Remarks, 3/9/10, emphasis added]

Spokesman Explained That Speaker Pelosi Was Referring To "People Hav[ing] Lost Sight Of What's Actually In The Bill." According to PolitiFact: "Separately, Pelosi spokesman Brendan Daly offered this interpretation of Pelosi's comment: 'She meant there was so much talk about process (in Congress) that people have lost sight of what's actually in the bill. Once it's passed, we can remind them of all the good things that are in it.'" [PolitiFact, 3/12/10]

Affordable Care Act's Medicare Savings Come From Eliminating Wasteful Overpayments, Not Cutting $500 Billion Cost Saving Provisions "Not A Slashing Of The Current Medicare Budget Or Benefits." According to "Whatever you want to call them, it's a $500 billion reduction in the growth of future spending over 10 years, not a slashing of the current Medicare budget or benefits. It's true that those who get their coverage through Medicare Advantage's private plans (about 22 percent of Medicare enrollees) would see fewer add-on benefits; the bill aims to reduce the heftier payments made by the government to Medicare Advantage plans, compared with regular fee-for-service Medicare. The Democrats' bill also boosts certain benefits: It makes preventive care free and closes the 'doughnut hole,' a current gap in prescription drug coverage for seniors." [, 3/19/10]

New England Journal Of Medicine: The Affordable Care Act Phases Out "Substantial Overpayments" To Medicare Advantage Plans. From the New England Journal of Medicine:

A phased elimination of the substantial overpayments to Medicare Advantage plans, which now enroll nearly 25% of Medicare beneficiaries, will produce an estimated $132 billion in savings over 10 years. [...]

The ACA also produces nearly $200 billion in savings by assuming that providers can improve their productivity as firms in other industries have done. On the basis of this presumed improvement, the law reduces Medicare's annual "market basket" updates for most types of providers — a provision that has generated controversy. [New England Journal of Medicine7/8/10]

Health Care Reform "Will Keep Paying Medical Bills For Seniors." According to PolitiFact: "The government-run Medicare program will keep paying medical bills for seniors, but it will begin implementing cost controls on health care providers, mostly through penalties and incentives. The legislation would reduce payments for hospital-acquired infections or preventable hospital admissions. For Medicare Advantage, the federal government intends to reduce extra payments, taking away subsidies to private insurance companies. Insurers will likely cut benefits in order to not lose profits. The bill does not address the 'doctor's fix,' an expected proposal that Congress usually passes to prevent doctors' Medicare payments from severe cuts." [PolitiFact, 3/18/10emphasis in original]

While Not Elected, IPAB Members Will Be Health Care Experts Confirmed By The Senate

IPAB Has 15 Full-time Members That The President Appoints And The Senate Confirms. According to the Kaiser Family Foundation: "IPAB is established as an independent board in the executive branch, composed of 15 full-time members appointed by the President and confirmed by the Senate. The statute sets out an array of qualifications for Board members: expertise in health care, economics, research and technology assessment, experience with employers and third-party payers, and consumers. It requires a balance between urban and rural representation. A majority of members must be non-providers." [Kaiser Family Foundation, April 2011]

Obama Wants To Fill The Board With "Doctors, Nurses, Medical Experts And Consumers." According to the Washington Post, "Obama hasn't nominated anyone yet, but said last month that he hopes to fill the slots with 'doctors, nurses, medical experts and consumers.'"  [Washington Post, 5/8/11]

IPAB Isn't "Unaccountable": Congress Has Authority To Make Final Decisions On Its Recommendations

IPAB Recommendation Process Requires Congress To Implement Proposal Or Pass An Amendment Meeting The Same Targets. According to law professor Timothy Jost, writing in the New England Journal of Medicine: "Each September 1, the IPAB must submit a draft proposal to the secretary of health and human services. On January 15 of the following year (beginning with 2014), the board must submit a proposal to Congress. If the board fails to submit a proposal on deadline, the DHHS must itself submit a proposal. Congress must consider the proposal under an expedited procedure. Congress cannot consider any amendment to the proposal that does not meet the same cost-reduction goals, unless both houses of Congress (and three fifths of the Senate) vote to waive this requirement. If Congress fails to adopt a substitute provision complying with the statute by August 15, the DHHS must implement the board's proposal." [New England Journal of Medicine, 7/8/10]

Sebelius: "Congress Still Has The Authority To Make Final Decisions." In her written testimony for a House Budget Committee hearing in July 2011, Health and Human Services Secretary Kathleen Sebelius wrote:

The Board's recommendations are also just that — recommendations — unless Congress fails to act. Congress still has the authority to make final decisions. [...]

The IPAB backstop means that if Medicare spending growth does exceed growth in the benchmarks, the IPAB will make specific recommendations, and Congress will then have the opportunity to take action. If Congress rejects IPAB recommendations, they will replace them with reforms that bring Medicare spending growth to or below the benchmark — achieving the same savings. The Board's recommendations will only go into effect if Congress accepts them, or if Congress fails to act. In other words, the IPAB recommendations are only implemented when excessive spending growth is not addressed, and other actions being taken are insufficient to bring spending to levels at or below the benchmark. [Secretary Sebelius Testimony, 7/12/11]

IPAB Is Prohibited From Rationing Care, Increasing Taxes, Or Changing Medicare Benefits Or Eligibility

Health Care Law Prevents IPAB From Rationing Care Or Raising Revenue. From the text of the Affordable Care Act:

(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 costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria. [The Patient Protection and Affordable Care Act, 3/23/10, emphasis added, via]

Kaiser Family Foundation: IPAB Cannot Ration Care, Increase Taxes, Change Benefits Or Eligibility, Or Increase Premiums And Cost-Sharing Requirements. According to the Kaiser Family Foundation: "The Board is prohibited from submitting proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income subsidies under Part D. Prior to 2019, the Board is also prohibited from recommending changes in payments to providers and suppliers that are scheduled to receive a reduction in their payment updates in excess of a reduction due to productivity adjustments, as specified in the health reform law." [Kaiser Family Foundation, May 2010] "It's Wrong To Say That The Advisory Board Will Ration Care." addressed Rep. Paul Ryan's (R-WI) claim that IPAB rations care:

Ryan twice warns of Obama's plan to "ration" health care for the elderly. He also says, "The greatest threat to the health security of America's seniors is the President's plan to deeply and systematically ration Medicare."

Ryan spokesman Conor Sweeney told us in an e-mail that the claim of rationing refers to funding for the Independent Payment Advisory Board created by the federal health care law. But it's wrong to say that the advisory board will ration care or that it will be run by bureaucrats, as we wrote when Sarah Palin made a similar claim.

The Patient Protection and Affordable Care Act says the advisory board "shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums." Also, the board isn't made up of Washington bureaucrats. The 15 voting members will be appointed by the president in consultation with congressional leaders; they must include doctors and other health care professionals, economists and health care finance experts, and representatives of consumers and seniors, as the American Medical Association explains. There will also be three non-voting members: the Health and Human Services secretary, and the administrators of the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration. [, 5/6/11, emphasis added]

IPAB's Role Is To Make Recommendations To Reduce Medicare Costs, Saving The Government Money

IPAB Makes Recommendations To Reduce Growth Of Medicare Spending. According to the Kaiser Family Foundation: "The 2010 health reform law (the Patient Protection and Affordable Care Act, also referred to as the ACA) establishes a new Independent Payment Advisory Board (IPAB) with authority to issue recommendations to reduce the growth in Medicare spending, and provides for the Board's recommendations to be considered by Congress and implemented by the Administration on a fast-track basis." [Kaiser Family Foundation, April 2011]

IPAB Helps Guarantee The Health Care Law's Medicare Cost-Containment Goals Will Be Reached. According to the Center for American Progress: "The Affordable Care Act establishes this board to serve as a guarantor that the law's cost-containment goals will actually be achieved. If the government's main health care program for the elderly and disabled Medicare exceeds its per capita cost-growth targets under the new law, then the Independent Payment Advisory Board is empowered to recommend ways to reduce program expenditures by changing the way Medicare pays health care providers." [Center for American Progress, 3/21/11]

IPAB Must "Recommend Reductions In Medicare If Spending Per Capita Is Projected To Exceed Specific Targets." According to the Washington Post: "Under the health care law, the board is required to recommend reductions in Medicare if spending per capita is projected to exceed specific targets. From fiscal year 2015 through 2019, that target is based on inflation gauges. Beginning in 2020, the target is based on the growth of the gross domestic product plus one percentage point. Proponents note that the IPAB won't impose a 'hard cap' on spending, but rather will recommend ways to reduce spending. 'IPAB is meant to be a fallback if the health law doesn't control spending as well as we think it will,' said Robert Kocher, head of McKinsey & Co.'s Center for U.S. Health System Reform and a former special assistant to Obama on health care." [Washington Post, 5/8/11]

Amount IPAB Can Cut Per Year Is Limited. According to the Center for American Progress: "Regardless of the [ACA Medicare spending] targets, the total amount that can be cut in any given year is limited; the annual limit starts at 0.5 percent of program spending for 2015, rising to 1.5 percent by 2018 and for later years. Both CBO and CMS project that Independent Payment Advisory Board-directed cuts through 2019 will be fairly small because other ACA provisions will produce most of the required savings. From 2020 on, CMS projects that no action by the new board will be required because the provider payment limits will achieve all the needed savings." [Center for American Progress, October 2010]