Sebelius: Congress can avoid IPAB by addressing Medicare costs

If Congress has the will to tackle Medicare spending, it won't have to worry about a controversial cost-cutting panel created by healthcare reform, Health and Human Services Secretary Kathleen Sebelius said Tuesday.

Republicans charge that the Independent Payment Advisory Board (IPAB) will "ration" seniors' care. It has been a top target in the GOP's assault on President Obama's healthcare law. The 15-member board will recommend cuts in Medicare payments to doctors, which will take effect automatically unless Congress votes to block them.

But the IPAB's power only kicks in if Medicare spending grows at a certain rate. So lawmakers worried about handing over control of Medicare payments to an unelected board can avoid that scenario by controlling Medicare costs before the IPAB is in place, Sebelius said.

"If Congress is actually paying attention to the bottom line of Medicare, IPAB is irrelevant,” Sebelius said Tuesday at a House Budget Committee hearing on the IPAB.

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Some Democrats agree with Ryan and want to see the IPAB repealed.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.

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