Although Democratic supporters of the board are quick to emphasize that Congress can block the IPAB's cuts from taking effect, the panel was conceived in large part as a way around the political pressures that often prevent Congress from cutting doctors' payments.
Sebelius also defended the board against charges of rationing, noting that the healthcare law prohibits the IPAB from cutting benefits or shifting costs to seniors.
But Committee Chairman Paul Ryan (R-Wis.) said the IPAB's power over rates for doctors is all it needs to deny seniors needed care. As payments for particular services are cut, fewer doctors will perform those services for Medicare patients, and eventually care will become unavailable, he said.
“Isn’t that effectively rationing in and of itself?” Ryan asked.
Sebelius conceded Ryan's argument that Medicare spending is unsustainable on its current trajectory, a problem he says calls for a major overhaul, such as his plan to covert the program into a sort of voucher system. Letting seniors choose among private health insurance plans is better than empowering the IPAB to cut doctors' rates, Ryan argued.
"We don’t think we should invest all of the power and money decisions into the hands of 15 people who aren’t even elected," he said.
Some Democrats agree with Ryan and want to see the IPAB repealed.
Rep. Allyson Schwartz (D-Pa.) is among the handful of Democratic co-sponsors for bill to repeal the panel, and she's testifying at a separate hearing about the IPAB on Wednesday.
But when Schwartz got her turn to ask questions at Tuesday's hearing, she didn't mention the IPAB.