View: Congress doesn't understand health costs, or care

In particular, the IPAB is designed to provide a backstop if health costs grow beyond Congress's control. Presumably, Congress will be more likely to act if members know that failing to do so means the IPAB will step in. Those favoring repeal of the IPAB either oppose a shift away from fee-for-service payment, or believe that Congress is about to become much more adept at complicated payment reform than it has ever been in the past.

Critics of the IPAB make several other claims as well. One is that the IPAB will ration care or simply adopt blunt payment cuts. By law, though, the IPAB is prohibited from rationing care, and it isn't needed for the kind of blunt payment cuts that Congress has often pursued. It's designed to smooth the transition to payment models like accountable care organizations and bundled payments.

Critics also point out that the IPAB's thresholds for action are not currently binding, and that no one has been nominated to serve on the board. The latter concern can be rectified and, in any case, if the board never stands up, its authority would still exist, albeit in the hands of the secretary of Health and Human Services. With regard to the cost thresholds, the whole point of the IPAB is to provide a backstop in the event costs begin rising too fast.

See also: House Eyes Medicare Fee-Setter Insulation

The shift toward paying for value in health care is just beginning. Many doctors, hospitals and other providers feel as if they have one foot on the boat and one still on the dock. Removing the IPAB now would suggest it makes sense to step backward toward fee-for-service payments — just as costs are rising again.